We have reached single-visit testing, diagnosis, and treatment for hepatitis C infection, now what?

ABSTRACT

Introduction

Progress toward hepatitis C virus (HCV) elimination is impeded by low testing and treatment due to the current diagnostic pathway requiring multiple visits leading to loss to follow-up. Point-of-care testing technologies capable of detecting current HCV infection in one hour are a ‘game-changer.’ These tests enable diagnosis and treatment in a single visit, overcoming the barrier of multiple visits that frequently leads to loss to follow-up. Combining point-of-care HCV antibody and RNA tests should improve cost-effectiveness, patient/provider acceptability, and testing efficiency. However, implementing HCV point-of-care testing programs at scale requires multiple considerations.

Areas covered

This commentary explores the need for point-of-care HCV tests, diagnostic strategies to improve HCV testing, key considerations for implementing point-of-care HCV testing programs, and remaining challenges for point-of-care testing (including operator training, quality management, connectivity and reporting systems, regulatory approval processes, and the need for more efficient tests).

Expert Opinion

It is exciting that single-visit testing, diagnosis, and treatment for HCV infection have been achieved. Innovations afforded through COVID-19 should facilitate the accelerated development of low-cost, rapid, and accurate tests to improve HCV testing. The next challenge will be to address barriers and facilitators for implementing point-of-care testing to deliver them at scale.

KEYWORDS:

• Point-of-care
• diagnostics
• rapid
• PWID
• HCV
• antibody
• RNA
• lateral flow

Article highlights

• There are a range of diagnostic testing strategies, including point-of-care tests, that can be combined to improve testing, linkage to care, and treatment for hepatitis C infection.

• The implementation of these strategies will depend on a range of factors including the prevalence of infection, the ease of implementation, setting, preference for different specimen collection techniques, and testing costs.

• Programs have been developed to facilitate national scale-up of point-of-care HCV testing, but require careful consideration of program operations, point-of-care operator training, quality management, and connectivity and reporting systems.

• Remaining challenges for point-of-care testing include enhanced operator training programs, improved quality management, enhanced systems for connectivity and reporting, more streamlined regulatory approval processes, and the need for more efficient tests.

• Innovations afforded through COVID-19 should facilitate the accelerated development of low-cost, rapid, and accurate tests to improve HCV testing.

Declaration of interests

JG is supported by a National Health and Medical Research Council Investigator Grant (1176131). GD is supported by a National Health and Medical Research Council Investigator Grant (2008276). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosure

Peer reviewers in this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the commentary concept. JG wrote the first draft of the review.

Acknowledgments

The Kirby Institute is funded by the Australian Government Department of Health and Ageing. The views expressed in this publication do not necessarily represent the position of the Australian Government.

Additional information

Funding

This paper was not funded.