HCV treatment uptake following point-of-care HCV testing at a mobile community clinic in Queensland, Australia: The Kombi Clinic

Author: Joss O'Loan, Mim O'Flynn, Matt Young, Ineke Shaw, Corey Markus, Maria Martinez, David Silk, Simon Comben, Stephanie Davey, Evan Cunningham, Susan Matthews, Jason Grebely

Theme: Models of Care Year: 2023

Background: Increasing HCV testing in key populations, such as people who inject drugs, is hampered by current diagnostic pathways requiring multiple visits, which frequently lead to loss to follow-up and disengagement from care. This study evaluated treatment uptake following hepatitis C virus (HCV) point-of-care testing through a community-based mobile clinic in Queensland, Australia (Kombi Clinic).

Methods: This observational study included people receiving point-of-care HCV testing through a community-led mobile clinic in Queensland, Australia. Kombi Clinic operates from an awesome yellow Kombi Van, with General Practitioners and a Nurse wearing rad Hawaiian shirts. Outreach clinics run at drop in centers, rough sleeping locations, community corrections, and GP clinics. Participants received point-of-care HCV testing (Abbott Bioline HCV antibody testing and/or Xpert HCV Viral Load Fingerstick testing), linkage to nursing/physician care, and HCV treatment. The primary outcome was HCV treatment uptake in the three months following testing.

Results: Between 16 Feb 2022 and 24 Feb 2023, 577 people received HCV testing (30% female, median age 42 years; 28% Aboriginal and/or Torres Strait Islander; 40% injecting drug use in the previous six months, 18% receiving opioid agonist therapy). 254 people received HCV antibody testing and 357 received HCV RNA testing. HCV RNA was detectable in 12% (67/577) overall and 18% (67/357) among those who received HCV RNA testing. Among people with detectable HCV RNA (n=67), 34% (n=23) had previously received treatment. Overall, 68% (46/67) initiated HCV treatment.

Conclusions: Point-of-care HCV RNA testing provided through a community-based mobile clinic can achieve large numbers of people tested and treated from key populations. Further work is needed to evaluate the effectiveness and cost-effectiveness of this intervention as a strategy to scale-up of HCV testing/treatment in the community to facilitate HCV elimination.

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