Pilot HCV birth cohort screening in UK primary care using a postal oral fluid home testing kit: The HEPCAPP study.


Author: Matt Hickman

Theme: Epidemiology & Public Health Research Year: 2023

Background: Birth cohort screening has been implemented in other countries to address the potentially ‘missed population’ of undiagnosed chronic HCV in people who may not have been found through targeted screening. In England an ~74,600 were living with chronic HCV, the majority of whom have an injecting history. We piloted a model, whereby individuals (40-64yrs) in participating general practices were invited to have an HCV test using an oral swab posted to their homes.

Methods: Eligible participants from 25 general practices were invited by sending an invitation letter with an electronic link to the Patient Information leaflet and consent form. Participants consenting to the study were sent an oral swab kit in the post and asked to return their sample in a prepaid return envelope. Saliva samples were tested for antibody to HCV by the UKHSA Virus Reference laboratories. Primary outcome was uptake of testing; secondary outcomes were yield in terms of number and proportion HCV antibody positive cases detected; number of chronic cases detected and whether cases had HCV risk markers recorded in primary care and could have been identified through targeted screening.

Results: Of the 98,396 patients registered at participating general practices, 16,436 (16.7%) completed a consent form and were sent an oral swab kit. 47% were ≥55years and 55% were female. 12,216 (74%) returned a kit, with 31 participants (0.25%) testing positive for HCV antibody. 45% of those positive had a risk marker on their primary care record. 6% were confirmed RNA positive and referred for treatment, those RNA positive had risk markers.

Conclusion: Wide-scale HCV screening of the general public using a postal oral fluid home testing kit was acceptable and identified people infected with HCV. However, the majority also had other risk markers and so could have been detected through targeted screening.

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