“That was quick, simple, and easy”: Patient perceptions of acceptability of point-of-care hepatitis C RNA testing at a reception prison

Lafferty, Lise; Cochrane, Amanda; Sheehan, Yumi; Treloar, Carla; Grebely, Jason; Lloyd, Andrew R.

doi:10.1016/j.drugpo.2021.103456

Cited by 16 publications

(15 citation statements)

References 31 publications

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“…Prior to availability of DAAs in Australia (March 2016), treatment uptake was low, with lifetime treatment rates among people who inject drugs estimated between 8 and 20% 24,25 . Since widespread availability of DAAs in Australia, treatment rates have increased significantly among all people living with hepatitis C, including people who inject drugs 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Point‐of‐care (POC) testing for hepatitis C could potentially overcome these barriers by providing same‐day results and expediting linkage to care. POC testing also broadens access to opportunistic testing in novel, acceptable settings for people who inject drugs such as needle and syringe exchange programs (NSPs) 22‐24 . We have previously reported the high proportion of PWID who underwent POC hepatitis C testing in the Rapid EC pilot study 17 .…”

Section: Introductionmentioning

confidence: 99%

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The impact of point‐of‐care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study

Howell

Traeger

Williams

et al. 2022

Journal of Viral Hepatitis

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Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV) testing in people who inject drugs. This study assessed impact on hepatitis C treatment uptake of POC HCV testing in needle and syringe exchange programs (NSPs). Rapid EC was a single-arm interventional pilot study of HCV POC testing conducted in three inner-city community clinics with NSPs. Twelve months after the POC testing, a retrospective medical record and Pharmaceutical Benefits Scheme audit was performed to determine the number of HCV RNA-positive participants who were prescribed HCV treatment. 70 HCV RNA-positive Rapid EC study participants were included. 44 (63%) were prescribed DAAs; 26 (59%) completed treatment and 15 (34%) had SVR testing, all of whom were cured. Age ≥ 40 years (aOR 3.45, 95% CI 1.10-11.05, p = .03) and secondary school education (aOR 5.8, 95% CI 1.54-21.80, p = .009) had higher likelihood of being prescribed DAAs, whereas homelessness was inversely associated with prescription of DAAs (aOR 0.30, 95% CI 0.09-1.04, p = .057). Median time to receive a DAA script from date of diagnosis was seven days (IQR 0 to 14 days), and time to filling the DAA prescription was 2 days (IQR 0-12 days). In conclusion, provision of

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The impact of point‐of‐care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study

Howell

Traeger

Williams

et al. 2022

Journal of Viral Hepatitis

View full text Add to dashboard Cite

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“…By contrast, semi‐quantitative visual read POC lateral flow tests in a single test cartridge are easy to use and interpret and can be performed quickly at the population level, as shown in Egypt and Pakistan where they have been used for hepatitis C screening with phenomenal success 15,25 . POC tests also have high levels of acceptability and feasibility among affected populations and health workers 13,26 . Our data suggest that while the Axxin reader provides a full quantitative result for ALT1, which is useful in many settings, the POC ALT1 visual read semi‐quantitative test provides similar accuracy for detection of clinically significant ALT elevations >40 IU/L and is, therefore, an acceptable alternative to the use of a handheld POC test reader.…”

Section: Discussionmentioning

confidence: 86%

“…15,25 POC tests also have high levels of acceptability and feasibility among affected populations and health workers. 13,26 Our data suggest that while the Axxin reader provides a full quantitative result for ALT1, which is useful in many settings, the POC ALT1 visual read semi-quantitative test provides similar accuracy for detection of clinically significant ALT elevations >40 IU/L and is, therefore, an acceptable alternative to the use of a handheld POC test reader.…”

Section: Validation Cohortmentioning

confidence: 81%

Validation of a novel point‐of‐care test for alanine aminotransferase measurement: A pilot cohort study

Howell

Van

Pham

et al. 2023

Liver International

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Background Alanine aminotransferase (ALT) measurement is essential for evaluation of liver disease. We validated a novel rapid point‐of‐care (POC) test for ALT1 against laboratory ALT. Methods Stored plasma samples from adults with chronic liver disease (Test cohort n = 240; Validation cohort n = 491) were analysed using the BioPoint® antigen immunoassay POC ALT1 lateral flow test, which provides quantitative ALT results (Axxin handheld reader) or semi‐quantitative results (visual read, cut off 40 IU/ml). The accuracy of POC ALT1 to detect ALT > 40 IU/L was determined by ROC analysis. In patients with chronic hepatitis B, treatment eligibility (EASL criteria) was determined using POC ALT1 and compared to laboratory ALT. Results POC ALT1 test had good accuracy for laboratory ALT > 40 IU/L: AUROC 0.93 (95% CI: 0.89–0.96) in the Test cohort and AUROC 0.92 (95% CI: 0.88–0.95) in the Validation cohort. POC ALT1 cut off of 0.8 for ALT > 40 IU/L maximised sensitivity (97%) and specificity (71%) in the Test cohort (42% laboratory ALT > 40 IU/L) and yielded PPV 84% and NPV 91% in the Validation cohort (19% laboratory ALT > 40 IU/L). Semi‐quantitative POC ALT1 had good accuracy for laboratory ALT in the Validation cohort (AUROC 0.85, 95% CI: 0.81–0.99; sensitivity 77% and specificity 93%). Combined with HBV DNA and transient elastography, both quantitative and semi‐quantitative POC ALT1 tests had good accuracy for excluding hepatitis B treatment needs (sensitivity 96%, specificity 78% and NPV 99%). Conclusion The POC ALT1 test had good accuracy for elevated ALT levels and for determining treatment eligibility among people with chronic hepatitis B.

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“…Although views of imprisoned people on the acceptability of PoC testing did not form part of the work undertaken here, other studies have examined this. A qualitative substudy on the Australian project showed that the PoC intervention was highly acceptable to participants 38. Other work found testing in this manner highly acceptable, with most preferring it to venepuncture 39.…”

Section: Discussionmentioning

confidence: 99%

Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison

et al. 2023

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ObjectivesHepatitis C virus (HCV) poses a global public health threat. Prisons are a focus of prevention efforts due to high infection burdens. Expedition of treatment for incarcerated people is critical, as many are short-term sentenced. We evaluated point-of-care (PoC) HCV RNA testing in a maximum-security Scottish prison and assessed its impact on transition to treatment. We also evaluated costs and determinants of implementation.DesignMixed-methods evaluation of a single-centre care pathway pilot using National Health Service (NHS) data from 2018 to 2021. Descriptive statistics and survival analysis were undertaken. Cost analysis was assessed from a provider perspective. Healthcare staff participated in semistructured interviews and thematic analysis with a deductive approach was undertaken to identify implementation determinants.SettingA large maximum-security Scottish prison health centre administered by the NHS.Participants296 incarcerated NHS patients (all men) and six NHS staff members (two men and four women).InterventionsHCV testing using the Cepheid GeneXpert platform with Xpert HCV VL Fingerstick assay.Outcome measuresThe main outcome was survival (in days) from HCV test to treatment initiation. Secondary outcomes were cost-per-cure obtained and implementation determinants.ResultsDuring the pilot, 167 Xpert tests were administered, with an 84% completion rate, and treatment transition was superior for those who received it (p=0.014). Where PoC tests were administered, shorter survival to treatment was observed (19 vs 33 days: adjusted HR (aHR) 1.91 (1.03–3.55), p=0.040; 19 vs 50 days; aHR 3.76 (1.67–8.46), p=0.001). PoC was costlier than conventional testing. In qualitative analysis, most facilitators were observed among characteristics of individual domain while most barriers were noted in the inner setting.ConclusionsIntegrating PoC HCV RNA diagnosis into nurse-led HCV care in a maximum-security prison health centre shortens survival to HCV treatment. However, there are cost implications to this approach and multiple determinants that impact on implementation should be addressed.

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“That was quick, simple, and easy”: Patient perceptions of acceptability of point-of-care hepatitis C RNA testing at a reception prison

Cited by 16 publications

References 31 publications

The impact of point‐of‐care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study

The impact of point‐of‐care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study

Validation of a novel point‐of‐care test for alanine aminotransferase measurement: A pilot cohort study

Mixed-methods evaluation of point-of-care hepatitis C virus RNA testing in a Scottish prison

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