Strategies for Hepatitis C Testing and Linkage to Care for Vulnerable Populations: Point-of-Care and Standard HCV Testing in a Mobile Medical Clinic

Abstract

Despite new Hepatitis C virus (HCV) therapeutic advances, challenges remain for HCV testing and linking patients to care. A point-of-care (POC) HCV antibody testing strategy was compared to traditional serological testing to determine patient preferences for type of testing and linkage to treatment in an innovative mobile medical clinic (MMC). From 2012 to 2013, all 1,345 MMC clients in New Haven, CT underwent a routine health assessment, including for HCV. Based on patient preferences, clients could select between standard phlebotomy or POC HCV testing, with results available in approximately 1 week versus 20 min, respectively. Outcomes included: (1) accepting HCV testing; (2) preference for rapid POC HCV testing; and (3) linkage to HCV care. All clients with reactive test results were referred to a HCV specialty clinic. Among the 438 (32.6 %) clients accepting HCV testing, HCV prevalence was 6.2 % (N = 27), and 209 (47.7 %) preferred POC testing. Significant correlates of accepting HCV testing was lower for the "baby boomer" generation (AOR 0.67; 95 % CI 0.46-0.97) and white race (AOR 0.55; 95 % CI 0.36-0.78) and higher for having had a prior STI diagnosis (AOR 5.03; 95 % CI 1.76-14.26), prior injection drug use (AOR 2.21; 95 % CI 1.12-4.46), and being US-born (AOR 1.76; 95 % CI 1.25-2.46). Those diagnosed with HCV and preferring POC testing (N = 16) were significantly more likely than those choosing standard testing (N = 11) to be linked to HCV care within 30 days (93.8 vs. 18.2 %; p < 0.0001). HCV testing is feasible in MMCs. While patients equally preferred POC and standard HCV testing strategies, HCV-infected patients choosing POC testing were significantly more likely to be linked to HCV treatment. Important differences in risk and background were associated with type of HCV testing strategy selected. HCV testing strategies should be balanced based on costs, convenience, and ability to link to HCV treatment.

Evidence-based interventions to enhance assessment, treatment, and adherence in the chronic Hepatitis C care continuum

“…The remaining 6 screening-related interventions (Table 1) demonstrate high rates of uptake and case-finding when interventions target high-risk individuals in specific settings, including PWID in NSPs (Aitken, Kerger, & Crofts, 2002), patients in a primary care clinic with certified methadone prescribers (Cullen et al, 2006), patients in specialty addiction treatment clinics and prison (Craine et al, 2014; Hickman et al, 2008), patients in a mobile medical clinic (Morano et al, 2014), and individuals with co-occurring substance use and serious psychiatric disorders in community mental health programs (Slade et al, 2013). The interventions described include free counseling and testing (Aitken et al, 2002), point-of-care testing (Morano et al, 2014), streamlined screen-test-immunize-reduce risk-refer protocols (Slade et al, 2013), dried blood spot testing (Craine et al, 2014; Hickman et al, 2008), and provider education with nursing support (Cullen et al, 2006). Programs were found to be generally effective at identifying new cases of chronic HCV and cost-effective when compared to treatment-as-usual, though often they required ancillary structural support to increase testing rates.…”

“…These studies demonstrated that patients with ongoing drug use and psychiatric comorbidity-- those traditionally excluded from systems of care-- can be effectively linked to care from and sometimes treated within these settings (Bruce et al, 2012; Jack, Willott, Manners, Varnam, & Thomson, 2009; McAllister et al, 2014; Morano et al, 2014; Newman et al, 2013; Seidenberg et al, 2013). One study implemented an integrated, multidisciplinary medical group visit to integrate care (Ho et al, 2013).…”

“…Rapid point-of-care screening tests for HCV antibodies were FDA-approved in 2010, allowing screening to be expanded to non-clinical settings (Stockman, 2014), but implementation strategies have not yet been rigorously evaluated or published, with the exception of one preference study (Morano et al, 2014). …”

Exposure to hepatitis C virus in homeless men in Central Brazil: a cross-sectional study

“…The questionnaire was based on previously validated studies in populations of homeless and tested in a pilot study [11, 17–22]. Antibodies to HCV (anti-HCV) were detected by using rapid tests on capillary blood collected by finger-stick, as recommended by the World Health Organization and the Ministry of Health of Brazil for vulnerable populations [23, 24]. The test was interpreted ten minutes after the collection and the result was given to the patient during post-test counseling.…”

Experience with phlebotomy for people with hepatitis C: a systematic review

“…We focus specifically on experience of, and interventions to improve, phlebotomy in people with HCV. A recent systematic review examining interventions to improve treatment (Meyer et al 2015) only identified a single study related to phlebotomy, which was a comparison of standard phlebotomy and point of care testing for HCV screening (Morano et al 2014). We limited our search to studies reported in English.…”