Rapid Point-of-Care Testing for Hepatitis C – Assessment of Feasibility, Knowledge of Participants and Outcomes.
In New Zealand, approximately 50,000 people or more are infected with hepatitis C(HCV), and only 50% or less are currently diagnosed. HCV infection(and related complications) is presently the single most common diagnosis leading to liver transplantation in New Zealand. With current treatments, HCV infection has a high cure rate and the foremost hurdle to eradication is the identification of those infected. A blood test to detect HCV antibodies is currently used as the initial test. Trained personnel, expensive equipment and repeated appointments are required in the current HCV care cascade which increases the number of patients lost to follow-up. A point-of-care test is a swift testing method that allows individuals to be tested, informed of the results and further management started during the same visit. The OraQuick HCV point-of-care test has high sensitivity and specificity and is validated against traditional EIA testing methods. This test detects HCV antibodies and confirmation of active infection is needed with an RNA test after a positive antibody test. The study assessed the feasibility of point-of-care HCV testing in a general practice setting and at a sexual health clinic in Dunedin, New Zealand and aimed to gain insights into participants’ knowledge and experience with the test. HCV point-of-care tests were offered to patients aged 45 to 65 years as well as anyone at least 18 years old with a risk factor for hepatitis C. Mouth swab testing(n=111;50.9%) was used in the initial phase and finger-prick testing(n=107;49.1%) later. Volunteers with known hepatitis C were tested as well using both testing methods and the tests were positive. Data collected included demographics, risk factors for HCV infection and participant experience with the testing method. A questionnaire was used to assess knowledge regarding viral hepatitis. Data variables have been analysed with significance defined at p < 0.05. A total of 218 participants were recruited for the study. The median age was 29 years(IQR 22 to 46). Fifty six percent(n = 122) of the participants were female. All the test via the finger prick method were negative. Fourteen mouth swab tests were false positive. One person was detected to have an active HCV infection and managed and cured as per guidelines. On knowledge-based questions the study population scored a median of 58.3% (IQR 50 to 75). There were no statistically significant differences in percentage of correct answers between participants with different levels of education, F(4, 213) = 0.857, p =0.491. A majority of study participants (93.6%) reported that they preferred to get their results on the same day and that the point-of-care test caused less anxiety(74.8%) compared to a usual blood test. There were no complications of administering the rapid point-of-care test. Point-of-care testing for HCV is feasible and preferred by participants. Only one person with active HCV infection was detected. Future studies should take into consideration the number of false positives via the mouth swab method of testing in this study. Knowledge regarding hepatitis C was low among participants. This study has also provided valuable insights into the viability and participants’ experience of offering point-of-care testing for HCV in New Zealand. The results form the basis for a larger trial with multiple sites across the country and a higher number of participants.
Advisor: Johnson, Steven; Schultz, Michael
Degree Name: Master of Medical Science
Degree Discipline: Medicine
Publisher: University of Otago
Keywords: Hepatitis C; point-of-care testing; Hepatitis C care cascade; Hepatitis C awareness
Research Type: Thesis