Point-of-care testing to diagnose HCV infection has the potential to eliminate the need for multiple appointments to confirm chronic infection. An oral antibody test can provide a result in 20 minutes. For those who test antibody positive, a viral load test (Xpert HCV Viral Load) on a blood sample drawn by venepuncture can provide confirmation of chronic infection in around two hours.
Would point-of care testing be acceptable to people who inject drugs? Improving the uptake of testing and engagement in care of people who inject drugs is critical for elimination of hepatitis C. The need for multiple appointments and visits to unfamiliar health care facilities has been identified as a barrier to care for people who inject drugs, whereas point-of-care testing has the potential to engage people at community-based testing sites such as needle and syringe programmes.
To investigate the testing preferences of people who inject drugs, researchers from the Burnet Institute in Melbourne carried out a pilot study of point-of care testing at needle and syringe programmes in the city. A qualitative study interviewed 19 people who had undergone point-of-care testing to learn more about the acceptability of point-of-care testing.
Study participants were predominantly male (74%), with a median age of 44 years. All had injected drugs in the previous month, with a median of 28 injecting episodes during that period. Fifteen of 19 tested positive for HCV antibodies and six were RNA positive on a viral load test.
Although none reported sharing needles or syringes in the preceding six months, sharing of injecting equipment such as spoons, filters and water was reported by a substantial minority (for example, 37% reported that they had shared a spoon with others after using it themselves, so-called distributive sharing).
Participants valued the fact that testing was carried out by needle and syringe programme staff who were not judgmental.
They also preferred mouth swab collection of oral samples for antibody testing.
“It’s like less hassle …getting blood sounds really intense, but doing a mouth swab, sounds really nonchalant …I’d come every week if that’s all it was,” said a 21-year old user of the service.
Some participants valued the fact that they were permitted to take a blood sample themselves, after bad experiences in other health care settings of trying to obtain blood from damaged veins.
Although finger-stick sampling of blood for RNA testing is possible, most participants said that the ability to test a venous blood sample for other bloodborne viruses meant they preferred to give a venous sample. They also noted that venepuncture at the diagnosis visit would also allow pre-treatment tests to be done, reducing the need for future blood sampling.
A twenty-minute wait for an antibody test result was acceptable to all participants but waiting two hours at the needle and syringe programme for the result of an RNA test was considered too long to wait. Participants would prefer to return later in the day to get their results, but in fact, 10 out of 15 who underwent RNA testing did not get their result on the same day and when questioned about the speed of receiving this result, some participants said that they didn’t consider it urgent to find out the result, as “you’re not going to die straight away”.
By Keith Alcorn
Latham N et al. Community-based, point-of-care hepatitis C testing: perspectives and preferences of people who inject drugs. J Viral Hepatitis, advance online publication, 23 February 2019.