Straight To The Point – Lessons From The Rapid-EC Study: A Point-Of-Care Hepatitis C Testing Pilot In Needle And Syringe Programs Targeted To People Who Inject Drugs In Australia

Introduction: Point-of-care (POC) diagnostics offer advantages over conventional hepatitis C (HCV) testing: same-day diagnosis, testing outside traditional health services, provision by nonclinical staff and avoiding venipuncture. The Rapid-EC study assessed the feasibility and acceptability of providing HCV POC testing from needle and syringe exchange programs (NSPs). Methods: A prospective observational pilot study over a 3-month period, in three inner-Melbourne community clinics with NSPs. NSP workers, community health workers (CHWs), and nurses offered clients not engaged in HCV care an OraQuick HCV antibody mouth swab test (20 minutes); followed by a Xpert HCV viral load using serum (105 minutes). Same-day results were offered onsite, via phone, text message, or on return visit. All participants were offered confirmatory testing, all positive participants were booked into a follow-up appointment and linked to DAA treatment, where appropriate. Participants completed evaluation surveys and staff were interviewed. Results: 174 participants completed POC testing for HCV antibodies; 150 (86%) had a reactive result and who 140 (93%) underwent a POC HCV RNA test, of who 76 (54%) had detectable RNA. 7 of the 140 (5%) participants waited on-site to receive their POC RNA result, 85 (61%) opted for a phone call/text message. 104 of the 140 (74%) attended the follow-up visit within a median of 11 days (IQR 7-20 days). Clients reported strong preferences for POC tests (97/116, 85%) and CHW and NSP worker involvement in the testing process (104/106, 98%). Staff reported POC testing was a novel way to engage clients in HCV testing and streamline pathways to care. Conclusion: Provision of POC testing through NSPs was feasible and linked new clients into HCV testing and DAA treatment. POC testing reduces barriers for clients to access HCV testing and is a novel engagement tool that may help services retain clients in the HCV cascade of care. Disclosure of Interest Statement: The authors acknowledge funding support from the Shepherd Foundation, St Vincent’s Hospital Foundation, in-kind support from Cepheid Ltd., and an investigator initiated research grant from Gilead Sciences for this project. The Burnet also receives funding support from the National Health and Medical Research Council, Abbvie, GSK and Merck for investigator initiated research. The authors gratefully acknowledge the contribution of RapidEC participants, implementing sites and staff.

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