Point-of-Care Screening for a Current Hepatitis C Virus Infection: Influence on Uptake of a Concomitant Offer of HIV Screening

Abstract

Eliminating hepatitis C as a public health threat requires an improved understanding of how to increase testing uptake. We piloted point-of-care testing (POCT) for a current HCV infection in an inner-city Emergency Department (ED) and assessed the influence on uptake of offering concomitant screening for HIV. Over four months, all adults attending ED with minor injuries were first invited to complete an anonymous questionnaire then invited to test in alternating cycles offering HCV POCT or HCV+HIV POCT. Viral RNA was detected in finger-prick blood by GeneXpert. 814/859 (94.8%) questionnaires were returned and 324/814 (39.8%) tests were accepted, comprising 211 HCV tests and 113 HCV+HIV tests. Offering concomitant HIV screening reduced uptake after adjusting for age and previous HCV testing (odds ratio 0.51; 95% confidence interval [CI] 0.38–0.68; p < 0.001). HCV prevalence was 1/324 (0.31%; 95% CI 0.05–1.73); no participant tested positive for HIV. 167/297 (56.2%) POCT participants lived in the most deprived neighbourhoods in England. HCV RNA testing using finger-prick blood was technically feasible. Uptake was moderate and the offer of concomitant HIV screening showed a detrimental impact on acceptability in this low prevalence population. The findings should be confirmed in a variety of other community settings.

Consistent high prevalence of undiagnosed blood‐borne virus infection in patients attending large urban emergency departments in England

“…Our study used routinely collected ED data and was not designed to collect clinical data or other risk factors such as homelessness or injecting drug use. Further, our data pertain to populations triaged for a blood draw which may differ from low‐risk patients attending for minor injuries . Conversely, the requirement for surplus serum might add a bias against patients with poor venous access such as PWID, although this would have led to our results representing an underestimate.…”

“…Further, our data pertain to populations triaged for a blood draw which may differ from low-risk patients attending for minor injuries. 10 Conversely, the requirement for surplus serum might add a bias against patients with poor venous access such as PWID, although this would have led to our results representing an underestimate. The anonymous study model relied on local healthcare databases for known prevalence estimates, so prior diagnosis in another healthcare service using different laboratories cannot be excluded.…”

“…However, there is substantial US and emerging UK evidence of the effectiveness of electronic patient record (EPR) triggered ED BBV screening programmes and that subsequent engagement with the care cascade can be effective and sustainable . Molecular platforms now facilitate near‐patient nucleic acid testing, and results can be available within NHS ED waiting time targets . Coupled with improved therapy options, the environment now exists for new pathways to be considered for increased diagnosis and rapid linkage to care.…”

“…3,8 Molecular platforms now facilitate near-patient nucleic acid testing, and results can be available within NHS ED waiting time targets. 10 Coupled with improved therapy options, the environment now exists for new pathways to be considered for increased diagnosis and rapid linkage to care.…”

Improving HIV and HCV Testing in Substance Use Disorder Programs (SUDs) That Provide Medications for Opiate Use Disorder (MOUD): Role of Addressing Barriers and Implementing Universal and Site-Specific Approaches

“…The potential adoption of point-of-care (POC) HCV RNA testing strategy which uses GeneXpert technology as well as HIV POC testing (International Network on Health and Hepatitis in Substance Users, n.d.) approaches may be an alternative approach to venipuncture; this has been modeled successfully by attendees of harm reduction programs (Forns et al, 2022) or in Emergency Department settings (Geretti et al, 2018). This approach would require a change in workflow and investment in POC technology.…”