Community‐based, point‐of‐care hepatitis C testing: perspectives and preferences of people who inject drugs

Abstract

Summary A barrier to hepatitis C treatment for people who inject drugs (PWID) is needing to attend multiple appointments for diagnosis. Point‐of‐care hepatitis C tests provide results within 20 to 105 minutes and can be offered opportunistically in nonclinical settings such as needle syringe programmes. In this nested qualitative study, we explored the acceptability of point‐of‐care testing for PWID. PWID attending participating needle syringe programmes were screened using the OraQuick HCV antibody mouth swab (result in 20 minutes); those with a reactive result then underwent venepuncture for a point‐of‐care RNA test: the Xpert HCV Viral Load (result in 105 minutes). Convenience sampling was used to select participants for a semi‐structured interview. A hybrid thematic analysis was performed, guided by Sekhon's “Theoretical Framework of Acceptability.” Nineteen participants were interviewed. Three core themes emerged: "people and place," "method of specimen collection," and "rapidity of result return." It was highly acceptable to be offered testing at the needle syringeprogrammes by nurses and community health workers, who were described as competent and nonjudgemental. Most participants reported that even if a finger‐stick point‐of‐care RNA test were an option in the future, they would prefer venepuncture, as the sample could be used for pre‐treatment workup and bundled testing. Waiting 20 minutes to receive the antibody test result was acceptable, whereas the 105 minutes required for the RNA result was unacceptable. Offering point‐of‐care hepatitis C testing at needle syringe programmes is acceptable to PWID, however tests that avoid venepuncture are not necessarily the most attractive to PWID.

Reducing Read Time of Point-of-Care Test Does Not Affect Detection of Hepatitis C Virus and Reduces Need for Reflex RNA

“…With a positive antibody test at 5 minutes, a tester may immediately progress to collection for either dried blood spot HCV RNA testing, 17 or for on-site rapid HCV RNA testing such as the POC GeneXpert. 13,18 For the oral fluid test, our findings are in line with previous studies reporting that the test is more sensitive for viremic individuals than for nonviremic individuals but less reliable than blood testing (see Supplemental Materials). 19,20 After the 20-minute read time, even for viremic individuals, sensitivity was still not 100%, suggesting that the oral test should be reserved for use in which it is not possible to obtain a blood sample, at the cost of slightly reduced sensitivity, and no time saving.…”

“…Rapid POC testing has been used widely for many years to overcome obstacles in infectious disease screening. 12 Additionally, many studies have demonstrated that using peer/community members 13 for HCV POC testing, or testing in which people receive other services [14][15][16] improves the diagnostic cascade of care for HCV. However, further improvements are possible: shortening the 20-minute read time of the OQ test could significantly increase its utility in both high-and lowincome settings.…”

Usability and Acceptability of Oral-Based HCV Self-Testing Among Key Populations: A Mixed-Methods Evaluation in Tbilisi, Georgia

“…These results are consistent with a other studies conducted among MSM and PWID in the UK and Vietnam, which found HCVST to be easy to use and convenient [29,32]. Waiting 20 minutes to read the test result was acceptable and is consistent with a facility-based study in Australia among PWID [42].…”

Untreated alcohol use disorder in people who inject drugs (PWID) in France: a major barrier to HCV treatment uptake (the ANRS‐FANTASIO study)

“…In France, the ANRS‐AERLI programme, implemented in harm reduction centres, efficiently reduced HCV at‐risk practices and increased HCV testing . Similar programmes could be further enhanced by integrating other elements to improve the entire cascade of HCV care, such as adapted community‐based point‐of‐care testing , same‐day anti‐HCV and HCV RNA tests , nurse‐led services that facilitate linkage to care and integration of HCV care in the drug and alcohol setting , especially for individuals with comorbid AUD. Community‐based ‘test‐and‐treat’ approaches have also proved effective in local contexts, and may inspire future programmes targeting PWID .…”