Theme: Models of Care Year: 2024
Background: Despite significant improvements to hepatitis C testing and treatment in Australia, key populations still face unique barriers to accessing care. Peer-implemented point-of-care hepatitis C antibody testing with immediate reflex point-of-care RNA testing is a crucial advancement to outreach-based hepatitis C testing. The aim of the EMPOWER study is to evaluate this model.
Methods: EMPOWER is a sub-study of the National Australian Hepatitis C Point-of-Care Testing Program. Hepatitis NSW peer workers, who have lived experience of hepatitis C and treatment, work in partnership with healthcare teams to offer point-of-care testing at services accessed by priority populations. Trained peer workers engage with participants, conduct enrolment and consent, and assist with completion of a behavioural survey. Eligible participants are offered point-of-care hepatitis C antibody testing (INSTI; 1-minute to result) conducted by the peer worker, with immediate reflex to point-of-care hepatitis C RNA testing (GeneXpert Fingerstick Testing). People with a history of HCV infection instead receive immediate point-of-care RNA testing.
Results: During eight outreach events between August 2023 and February 2024, 141 unique participants were enrolled (29% female, median age 50 years, 32% reported recent injecting [last month], and 31% reported current homelessness). 99 antibody tests were performed by peer workers while 55 RNA tests were conducted by the healthcare team. 14% of those who received antibody testing were antibody positive, 93% of whom immediately received hepatitis C RNA testing on site. Overall, seven participants have tested RNA positive, of whom two have initiated treatment.
Conclusions/ Applications:
With 86% of participants being antibody negative, the EMPOWER project is reducing clinic time and resources spent on engaging and testing patients. Peer workers provide a supportive, non-judgmental, and effective pathway for affected communities to access hepatitis C testing and should be considered a central element in point-of-care testing in all outreach sites.