The impact of community-based rapid point-of-care testing on enhancing uptake of hepatitis C treatment for people who inject drugs in needle and syringe services.

Author: Jessica Howell, Bridget Williams, Michael Traeger, Joseph Doyle, Ned Latham, Bridget Draper, Chloe Layton, Frances Bramwell, Dean Membrey, Maggie Mcpherson M, Janine Roney, Alexander J Thompson, Margaret E Hellard, Alisa Pedrana

Theme: Epidemiology & Public Health Research Year: 2019

Background: Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV)
testing in people who inject drugs by allowing testing outside of traditional health services, provision
by non-clinical staff and same-day diagnosis. We assessed the feasibility and impact on treatment
uptake of POC HCV testing in needle and syringe exchange programs (NSPs).
Methods: Rapid EC was a single arm interventional pilot study conducted in three inner-city
community clinics with NSPs. Clinic staff offered clients not currently engaged in HCV care an
OraQuick HCV antibody mouth swab test followed by a serum Gene Xpert HCV viral load. Same-day
results were offered. Participants received confirmatory standard-of-care blood tests and a follow up
appointment for liver fibrosis assessment, results provision and linkage to care. Six months after the
intervention, a retrospective clinical audit was performed to determine the number of HCV RNA
positive participants who initiated HCV treatment, confirmed by national prescription data (PBS).
Results: 70/ 174 people (40%) who underwent POC testing for HCV were HCV RNA positive on
laboratory testing. Of these, 44 / 70 participants (63%) were prescribed HCV therapy and 35
participants (50%) commenced therapy. 26 participants completed treatment < six months (37% of those who were HCV RNA positive), of whom 15 had documented SVR12; 5 people did not complete treatment. Treatment initiation varied by clinic service model, highest at clinics A (76%) and B (71%) where NSPs were embedded within clinics compared with clinic C (27%) which had a co-located but separate NSP (p<0.001). Conclusion: HCV POC testing through NSPs was effective for linking people diagnosed with hepatitis C into care and treatment. Further studies are needed to define how best to incorporate POC testing into models of care for people who inject drugs to increase HCV treatment uptake and completion rates. Disclosure of Interest Statement: Funding support was received from the Shepherd Foundation, Gilead Sciences (Australia Fellowship JH), St Vincent’s Hospital Foundation and in kind support received from Cepheid. JH, JD and AP were supported by NHMRC fellowships. The Burnet also receives funding support from the National Health and Medical Research Council, Abbvie, GSK and Merck for investigator initiated research. The authors also acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program received by the Burnet Institute.

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