Evaluation of a UK Bristol capillary blood service for blood-borne virus detection to reach HCV elimination targets

Background
Capillary Blood-borne viruses (BBV) testing has been provided by UK Health Security Agency (UKHSA) Bristol laboratory since 2020 providing all-in-one testing for rapid Hepatitis C (HCV) Antibody and RNA, HIV antibody and RNA, Hepatitis B surface antigen and DNA and HCV genotype detection without the requirement for a venous blood sample. HCV operational delivery networks are dependent on a rapid turnaround time (TAT) of HCV RNA to enable treatment commencement. Further, a rapid genotype test can allow for bespoke treatment plans to utilise singular genotype drugs rather than pangenotypic drugs and therefore saving costs for the UK National Health Service. 
Methods
A retrospective study from 1st April 2022- 31st March 2023 looked at the capillary blood testing performed at the UKHSA Bristol laboratory. Data from the laboratory was linked to multidisciplinary teams (MDT) data from the local Bristol hepatology teams. 
Results
Between April 2022-March 2023, 1195 capillary blood tests were performed at the UKHSA Bristol laboratory. Of the 279 HCV RNA positive cases, a genotype was available in 278 cases. MDT outcomes were readily available for 86 individuals. Out of these 86 individuals, a sustained viral response at 12 weeks was achieved for 64 instances and treatment within 4 weeks of test result was available for 47 instances. Further, those with a genotype of 1 were able to be treated with grazoprevir/elbasvir regime (a non-pangenotypic regime) which allowed for a cheaper alternative to pangenotypic drug regimes. 
Conclusions
This study shows the importance of collaboration between laboratory and hepatology teams to provide a capillary blood service to improve diagnostic capabilities to enable rapid detection and treatment of hepatitis C and other bloodborne viruses in hard-to-reach populations. This study showed that a sustained viral response was seen in 64/86 individuals who tested positive tests for HCV. By reducing TAT of samples, we are able to treat HCV RNA positive individuals faster with the aim to prevent further transmission. With a genotypic test within the same blood sample, individuals do not have to be bled again and it reduced the requirement for a venous blood sample in population groups who are hard to bleed. Further, a genotype test can enable bespoke treatment plans to save costs whilst still aiming for hepatitis C elimination targets.