Making diagnosis of hepatitis C more accessible and closer to the community using point-of-care HCV viral load assays
Lancet Gastroenterology and Hepatology published a key new WHO-led study in collaboration with the University of Bristol showing the benefit of using a quick clinic-based diagnostic test for hepatitis C virus (HCV) infection over a standard laboratory-based test.
This new study pooled results from 45 studies (around 50% were from LMICs) and compared POC HCV viral load assays with centralized, laboratory-based standard approaches. It showed that using POC HCV viral load assays led to faster times from initial HCV antibody screening to starting on treatment (19 days compared to 67 days). Overall uptake of treatment was higher with POC assays at the clinic site (77%) or delivered in mobile units (81%) compared with standard laboratory-based assays (53%). The best results were seen when the POC assays were placed at a site where both testing and treatment were offered at the same location enabling treatment to be started on the same day as diagnosis.
The findings from this study led to recent WHO recommendations for adoption of POC HCV viral load testing as an alternative approach to laboratory-based platforms for diagnosing HCV infection and speeding up starting curative treatment. This recommendation complements other recent WHO recommendations in the same updated guidance for HCV diagnosis and treatment that promotes simplification of service delivery and task-sharing of testing and treatment to nurses and non-specialist doctors.
The optimal populations and settings for POC assays are hard to reach or marginalized populations at high risk of loss to follow-up, such as persons who inject drugs or persons experiencing homelessness. The POC assay can be placed in harm-reduction clinics, primary care clinics, prisons, in mobile units or even in community clinics, and offers the possibility of a one-stop, same-day diagnosis and treatment of HCV infection.
WHO is encouraging affected countries to consider including use of POC assays in their national policies on hepatitis C.
