Theme: Clinical Research Year: 2022
Background:
Increasing HCV testing is hampered by current diagnostic pathways requiring multiple visits and
frequent loss to follow-up, amplified in key populations, such as people in prison. This study
evaluated treatment uptake following an HCV point-of-care testing “blitz” (testing campaign) at one
prison in Queensland, Australia.
Methods:
This observational study included people receiving point-of-care HCV RNA testing at one male prison
in Queensland, Australia (n=1,080). Testing occurred over nine days (28 March–5 April 2022), with
one prison lockdown day where testing did not occur. The project was conducted through a
partnership with the health department, corrections, an outreach clinic, community-based
organisations, point-of-care training/quality assurance providers, and researchers. Participants
received point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick testing with four
GeneXpert IV platforms), linkage to nursing/physician care, and HCV treatment. The primary
outcome was HCV treatment uptake in the four weeks following testing.
Results:
Between 28 March 2022 and 5 April 2022, 673 males received HCV testing (median age, 35 years;
25% Aboriginal and/or Torres Strait Islander; 69% history of injecting drug use), representing 62% of
the prison population. Overall, 99% had valid test results (n=668) and 27% (182/668) had detectable
HCV RNA. 47% (85/182) had previously received HCV treatment. HCV DAA therapy was prescribed to
98% (179/182) of people in the four weeks following testing and 89% (162/182) have initiated
treatment.
Conclusions:
Point-of-care HCV RNA testing provided through a short-duration testing “blitz” can achieve large
numbers of people tested and treated. Collaborative partnerships between stakeholders were
critical. The high proportion having previously received treatment suggests a high reinfection rate,
indicating a need for enhanced prevention and treatment scale-up in prisons. Further work is
needed to evaluate the effectiveness and cost-effectiveness of this intervention as a strategy to
scale-up of HCV testing/treatment in prisons to facilitate HCV elimination.
Disclosure of Interest Statement:
GeneXpert machines and cartridges were provided through the National Australian Hepatitis C Point
of Care Testing Program through funding support from the Commonwealth Department of Health,
the National Health and Medical Research Council, Cepheid, Gilead Sciences, and AbbVie. JG is a
consultant/advisor and has received research grants from AbbVie, Cepheid, Gilead, and Merck
outside the submitted work.