Study Confirms Benefits of Point-of-Care HCV Testing on Cascade of Care

Point-of-care viral load assays for hepatitis C virus infection improved treatment uptake and time to treatment initiation for patients compared with centralized, laboratory-based assays, according to a recent global systematic review.

The study, published inThe Lancet Gastroenterology & Hepatology, included 45 observational studies published between Jan. 1, 2016 and April 13, 2022 and accepted conference abstracts. Among the studies included in the review, 28 involved people who inject drugs and/or were homeless, 4 involved people in prison, nine involved general populations and 4 involved people living with HIV.

“Using these point-of-care HCV viral load assays led to faster times from initial HCV antibody testing to starting on treatment compared with standard-of-care assays,” Adam Trickey, PhD, of the University of Bristol, told Contagion. “Therefore, the percentage of people that had been antibody tested that went on to start treatment was also higher, so there were substantial improvements in the HCV cascade of care when using these assays.”

The study showed that POC assays were associated with shorter times between testing and treatment initiation and higher treatment uptake. It also found that results were better when testing and treatment were provided at the same site and on the same day.

The pooled median turnaround times between HCV antibody testing and treatment initiation was 19 days (95% confidence interval 14–53) with onsite POC assays, compared with 64 days (64–64) with laboratory-based POC assays and 67 days (50–67) with laboratory-based SOC assays.

Treatment uptake was 77% (95% CI 72–83) with onsite POC assays, 81% (60–97) with mobile POC assays and 53% (31-75) than with SOC assays.

“These assays have been used in a range of settings and populations, including the general population and people living with HIV in low- and middle-income countries, as well as people who inject drugs and people in prisons in high-income countries,” Trickey said.

The study found that the increase in testing was greatest among people who inject drugs, were homeless, or both. The increase in treatment uptake was greatest among people incarcerated in prison.

The review confirmed sorter turnaround times in the POC groups in seven studies.

“Reducing the time taken between testing to receiving the test results to treatment means that there are fewer people that disengage with care along the way,” Trickey said.

In August, the World Health Organization updated recommendations for HCV, including calling for increased point-of-care testing of HCV RNA viral load.

Limitations of the study included the absence of randomized controlled trials comparing POC and laboratory-based SOC assays. The studies reviewed often relied on historical rather than concurrent data. Few of the studies reviewed included data on turnaround times.

The study authors noted that decentralized testing and treatment alongside other services is optimal, with the best outcomes coming when SOC assays are placed onsite or in mobile units in areas where there are populations at high risk of attrition.

Trickey said future research includes investigating the effect that these assays have on the cascade of care for other viruses, such as hepatitis B.