A national program to scale-up decentralized HCV point-of-care testing and treatment in Australia
Background: Fingerstick point-of-care HCV RNA testing enables diagnosis and treatment in a single-visit, increases testing acceptability, and reduces loss to follow-up. This analysis evaluated HCV testing, RNA prevalence, and treatment uptake (and associated factors) in a national program to scale-up point-of-care HCV testing. The proportion of people treated through the program among all people treated in Australia was also assessed.
Methods: The National Australian HCV Point-of-Care Testing Program is evaluating the scale-up of point-of-care HCV testing (antibody: Bioline HCV and INSTI; RNA: Xpert HCV Viral Load Fingerstick) through an observational study at 90 sites in Australia, including drug treatment clinics, needle and syringe programs, prisons, mental health services, homelessness services, Aboriginal Community Controlled Health Organisations, and mobile outreach clinics. The program facilitates point-of-care testing for anyone at risk of HCV or attending a service providing care for people at risk of HCV. The program includes standardised operator training for non-laboratory staff and a quality assurance framework. Factors associated with HCV treatment uptake among people with current HCV were identified through logistic regression analyses. The proportion of people receiving HCV treatment in the program from January 2022 and November 2023 among all people treated in Australia was assessed.
Results: Between January 2022 and November 2023, 83 sites (community, n=60; prison, n=23, 367 testing locations) are providing testing in all states/territories (253 operators trained). Overall, 15,603 HCV point-of-care tests have been performed (antibody, n=2,688; RNA, n=12,915), with 5,810 people tested in the community and 7,618 in prison. Among those receiving HCV RNA testing, 1,878 people (14%) have current HCV infection (community, 10%; prison, 17%). Among the evaluable population (reached 12 weeks post-testing), HCV treatment uptake is 79% (1,025/1,296) overall, including 52% (173/335) in the community and 89% (852/961) in prison. Among people with current HCV in the community (n=335), a history of opioid agonist treatment was associated with a greater odds of HCV treatment [adjust odds ratio (OR), 2.66, 95% CI: 1.24, 5,70]. People with >daily injecting drug use in the last 30 days (aOR 0.38, 95% CI: 0.20, 0.70) and people tested at a needle/syringe program [compared to drug treatment services; aOR 0.38 (95% CI: 0.21, 0.71) had a lower odds of HCV treatment]. Among HCV treatments between January 2022 and March 2023 in Australia, 9% (835 of 9294) of all treatments were provided through the program.
Conclusion: Onsite point-of-care HCV testing has led to high treatment uptake in prison settings in Australia. Given the lower treatment uptake in the community, interventions are needed to enhance HCV linkage to care and treatment following point-of-care testing, particularly among people attending needle and syringe programs.
