Pilot HCV Birth Cohort Screening in UK Primary Care using a postal oral fluid home testing kit: the HEPCAPP StudyPP STUDY

Background: Birth cohort screening has been implemented in multiple countries to address the potentially ‘missed population’ of undiagnosed chronic HCV in people who may not be found through targeted screening. In England ~74,600 were living with chronic HCV, the majority of whom have an injecting history. We piloted a model, whereby individuals (40-64yrs) in participating general practices were invited to have an HCV test using an oral swab posted to their homes.

Methods: Eligible participants from 25 general practices were invited by sending an invitation letter with an electronic link to the Patient Information leaflet and consent form. Participants consenting to the study were sent an oral swab kit in the post and asked to return their sample in a prepaid return envelope. Saliva samples were tested for antibody to HCV by the UKHSA Virus Reference laboratories. Primary outcome was uptake of testing; secondary outcomes were yield in terms of number and proportion HCV antibody positive cases detected; number of chronic cases detected and whether cases had HCV risk markers (PSI) recorded in primary care and could have been identified through targeted screening.

Findings: Of the 98,396 eligible patients contacted by UKHSA from participating practices, 16,436 (16.7%) were sent an oral swab kit. 47% were ≥55years and 55% were female.  Uptake was 12.4% (12,216 people returning a kit) and lower in young people and people from disadvantaged communities.  Yield was 0.25% (31) or per 100,000 for HCV antibody cases detected and 0.02% (2) or 2 per 100,000 with chronic HCV.  Both chronic HCV cases had PSI risk markers.   Cost per HCV antibody and chronic HCV detected was £16,000 and £248,000 respectively. 

Implications: Wide-scale HCV screening of the general public using a postal oral fluid home testing kit was acceptable with good uptake.  However, the yield was poor and not cost-effective and people diagnosed with chronic HCV could have been detected through targeted screening.