Point-of-care HCV RNA testing improves hepatitis C testing rates and allows rapid treatment initiation among people who inject drugs attending a medically supervised injecting facility

Michael B MacIsaac; Bradley Whitton; Jenine Anderson; Shelley Cogger; Dylan Vella-Horne; Matthew Penn; Anthony Weeks; Kasey Elmore; David Pemberton; Rebecca J Winter; Timothy Papaluca; Jessica Howell; Margaret Hellard; Mark Stoové; David Wilson; Alisa Pedrana; Joseph S Doyle; Nicolas Clark; Jacinta A Holmes; Alexander J Thompson

doi:10.1016/j.drugpo.2024.104317

Point-of-care HCV RNA testing improves hepatitis C testing rates and allows rapid treatment initiation among people who inject drugs attending a medically supervised injecting facility

Int J Drug Policy. 2024 Mar:125:104317. doi: 10.1016/j.drugpo.2024.104317. Epub 2024 Jan 28.

Authors

Michael B MacIsaac¹, Bradley Whitton², Jenine Anderson³, Shelley Cogger³, Dylan Vella-Horne³, Matthew Penn³, Anthony Weeks³, Kasey Elmore³, David Pemberton³, Rebecca J Winter⁴, Timothy Papaluca¹, Jessica Howell¹, Margaret Hellard⁵, Mark Stoové⁶, David Wilson⁷, Alisa Pedrana⁸, Joseph S Doyle⁸, Nicolas Clark⁹, Jacinta A Holmes¹, Alexander J Thompson¹⁰

Affiliations

¹ Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia.
² Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
³ Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia.
⁴ Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.
⁶ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.
⁷ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.
⁸ Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia.
⁹ Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia; Department of Addiction Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹⁰ Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia. Electronic address: alexander.thompson@svha.org.au.

PMID: 38281385
DOI: 10.1016/j.drugpo.2024.104317

Abstract

Background: To achieve hepatitis C virus (HCV) elimination targets, simplified care engaging people who inject drugs is required. We evaluated whether fingerstick HCV RNA point-of-care testing (PoCT) increased the proportion of clients attending a supervised injecting facility who were tested for hepatitis C.

Methods: Prospective single-arm study with recruitment between 9 November 2020 and 28 January 2021 and follow-up to 31 July 2021. Clients attending the supervised injecting facility were offered HCV RNA testing using the Xpert® HCV Viral Load Fingerstick (Cepheid, Sunnyvale, CA) PoCT. Participants with a positive HCV RNA test were prescribed direct acting antiviral (DAA) therapy. The primary endpoint was the proportion of clients who engaged in HCV RNA PoCT, compared to a historical comparator group when venepuncture-based hepatitis C testing was standard of care.

Results: Among 1618 clients who attended the supervised injecting facility during the study period, 228 (14%) engaged in PoCT. This was significantly higher than that observed in the historical comparator group (61/1,775, 3%; p < 0.001). Sixty-five (28%) participants were HCV RNA positive, with 40/65 (62%) receiving their result on the same day as testing. Sixty-one (94%) HCV RNA positive participants were commenced on DAA therapy; 14/61 (23%) started treatment on the same day as diagnosis. There was no difference in the proportion of HCV RNA positive participants commenced on treatment with DAA therapy when compared to the historical comparator group (61/65, 94% vs 22/26, 85%; p = 0.153). However, the median time to treatment initiation was significantly shorter in the PoCT cohort (2 days (IQR 1-20) vs 41 days (IQR 22-76), p < 0.001). Among participants who commenced treatment and had complete follow-up data available, 27/36 (75%) achieved hepatitis C cure.

Conclusions: HCV RNA PoCT led to a significantly higher proportion of clients attending a supervised injecting facility engaging in hepatitis C testing, whilst also reducing the time to treatment initiation.

Keywords: Elimination; Hepatitis C virus; Persons who inject drugs; Point-of-care; Supervised injecting facility; Xpert® HCV viral load fingerstick.

MeSH terms

Antiviral Agents
Drug Users*
Hepacivirus / genetics
Hepatitis C* / diagnosis
Hepatitis C* / drug therapy
Hepatitis C* / epidemiology
Hepatitis C, Chronic* / drug therapy
Humans
Needle-Exchange Programs
Point-of-Care Systems
Point-of-Care Testing
Prospective Studies
RNA, Viral
Substance Abuse, Intravenous*

Substances

Antiviral Agents
RNA, Viral