Community‐based screening of hepatitis C with a one‐step RNA detection algorithm from dried‐blood spots: Analysis of key populations in Barcelona, Spain

Abstract

Alternative strategies are required to enhance the diagnosis of silent hepatitis C virus (HCV) infections in key populations at risk. Among them, HCV prevalence and bio-behavioural data are scarce for HIV-negative men who have sex with men (MSM) and men and trans-women sex workers. We sought to describe and assess the potential benefits of a community-based one-step HCV screening and confirmatory strategy for these populations in Barcelona. The screening strategy based on a real-time RT-PCR assay for HCV-RNA detection in dried-blood spots (DBS) was validated and implemented in addition to an antibody point-of-care test in a community centre. HCV prevalence was assessed, and bio-behavioural data were collected. The molecular assay was precise, reproducible, sensitive and specific. Four HIV-negative MSM reported being currently infected (0.75% HCV self-reported prevalence). Implementation of DBS testing was easy, and acceptability was >95%, but no silent HCV case was diagnosed (N = 580). High-risk sexual practices and drug use for sex were reported frequently. HIV prevalence was 4.7% in MSM and 10% in sex workers. Self-reported prevalence of other STIs ranged from 11.3% to 36.2%. In conclusion, HCV-RNA testing in DBS showed a good performance, but the assessed one-step strategy does not seem beneficial in this setting. Although no silent HCV infections were detected, the observed high-risk behaviours and prevalence of other STIs suggest that HCV spread should be periodically monitored among these populations in Barcelona by means of behavioural surveillance, rapid antibody testing and molecular confirmation in DBS.

Evaluation of the diagnostic accuracy of laboratory-based screening for hepatitis C in dried blood spot samples: A systematic review and meta-analysis

“…The median prevalence was 51.1% for anti-HCV antibodies (p25th = 24.3%; p75th = 64.3%) and 61.8% for HCV-RNA (p25th = 60.5%; p75th = 70.1%). Eleven studies provided information about HCV genotypes in infected individuals 9,24,32,36,37,40,41,45–48 . Only 7 studies included the HIV/HCV coinfection status 24,28,29,31,37,38,47 .…”

“…39 —NoGermany——TMA: VERSANT HCV RNA Qualitative Assay (Siemens)TMA: VERSANT HCV RNA Qualitative Assay (Siemens)150100100100 2018 Saludes et al . 45 1, 2, 3, 4NoSpain——QuantiFast Pathogen RT-PCR + IC Kit (QIAGEN)Abbott RealTime HCV (Abbott Molecular)8238100100 2012 Santos et al . 44 NoBrazil——In-house qPCRIn-house qPCR1681019894.3 2002 Solmone et al .…”

Evaluation of a hepatitis C virus core antigen assay from venepuncture and dried blood spot collected samples: A cohort study

“…DBS collection has been demonstrated to facilitate HCV testing and linkage to care in populations where standard phlebotomy is a barrier . The performance of HCV RNA testing on DBS samples has been shown to be diagnostically and clinically comparable to plasma across multiple molecular platforms . However, the literature is limited when evaluating DBS for HCVcAg testing.…”

“…While the good performance of HCV core antigen in plasma has been demonstrated, there are many settings for which the collection or transport of plasma to a central facility is not possible. Dried blood spot (DBS) utility as an alternative sample type in HCV serology and molecular testing (NAT) has been well documented . The major advantages of finger‐stick capillary DBS testing are as follows: (a) simplified collection with no need for phlebotomy (through self‐ or assisted‐collection); (b) easy and affordable transportation of samples (no cold chain transport requirement as samples are stable at room temperature (24°C), with HCV RNA and core antigen stable for a year or more allowing shipment through the mail) and (c) multiple sample availability; as up to five spots are collected, which allows for reflex testing if confirmation is required or multi‐analyte testing.…”

Eliminating viral hepatitis C in Belgium: the micro-elimination approach

“…A generalised screening through dried blood spots in Barcelona did not detect any incident HCV in this subgroup. In contrast, highrisk behaviour and the incidence of other STIs suggested that periodic screening could be necessary in MSM [93]. Screening the specific subgroup with high-risk behaviour on PrEP is needed and is currently part of the reimbursement criteria for PrEP medication.…”