People undergoing diagnostic tests, including screening for viral infections, may sometimes face delays between having the test done and receiving the results. If the delay requires a repeated visit to a clinic or test site, some people fail to return for their results.
However, infection assessment technologies that can produce a rapid result that can then be quickly communicated by trained personnel to patients may be an attractive option. Not only do such tests reduce waiting time but patients with positive test results can, after counselling, be swiftly linked to the healthcare system for assessment, care and the offer of treatment.
Tests that are performed outside of a laboratory, such as in a doctor’s office or community health centre, are called point-of-care tests. A company called OraSure Technologies (Bethlehem, Pennsylvania) has developed a rapid oral fluid test for hepatitis C virus (HCV) antibodies called OraQuick. This test provides results in 20 minutes and was approved in the United States in 2010. Health Canada is assessing the data on this test in order to determine if it will be licensed.
Researchers in Wisconsin surveyed several hundred people who used a syringe and needle exchange program in urban and rural areas in that state about their attitudes toward rapid HCV testing. Among 413 participants who did not have a history of HCV infection and who responded to the survey, 85% were willing to undergo rapid HCV testing if it were made available. The results from the Wisconsin study underscore a high rate of acceptance of HCV rapid testing. If rapid HCV testing technology is approved in Canada, a similar survey should be done with key populations who could benefit from the use and availability of such tests.
Results
The researchers developed a questionnaire that participants completed by using electronic tablets. Analysis of the findings showed that participants who were younger than 30 years old and who perceived themselves at high risk for becoming infected with HCV were more likely to want to use rapid testing.
Integrated testing
The Wisconsin researchers stated that rapid HCV testing might be “a useful tool” for helping people at high risk for HCV to find out their infection status and linking them to care. Furthermore, they said:
“Although rapid HCV testing at syringe exchange programs may not turn the tide of the HCV epidemic, [it provides] a critical link to health services for a highly marginalized population who does not otherwise access the healthcare system.”
Other studies have also found that rapid HCV testing is something that would be welcomed by populations at high risk for HCV. A study in New York City among 129 young adults who injected street drugs found that a majority (83%) chose rapid HCV testing.
Another study in New Haven, Connecticut, found that participants whose HCV infection was uncovered with rapid testing (as opposed to standard testing) were significantly more likely to be connected to health care within a month of a positive test result.
Bear in mind
The presence of antibodies to HCV does not distinguish between past exposure to the virus and current active HCV infection. People who test positive for these antibodies need to be referred for HCV viral load testing so that doctors and nurses can assess whether active infection is present.
—Sean R. Hosein
REFERENCES:
- Barocas JA, Linas BP, Kim AY, et al. Acceptability of rapid point-of-care hepatitis C tests among people who inject drugs and utilize syringe-exchange programs. Open Forum Infectious Diseases. 2016 Apr 6;3(2):ofw075.
- Ward JW. Testing for HCV: the first step in preventing disease transmission and improving health outcomes for HCV-infected individuals. Antiviral Therapy. 2012;17(7 Pt B):1397-401.
- Morano JP, Zelenev A, Lombard A, et al. Strategies for hepatitis C testing and linkage to care for vulnerable populations: point-of-care and standard HCV testing in a mobile medical clinic. Journal of Community Health. 2014 Oct;39(5):922-34.
- Hayes B, Briceno A, Asher A, et al. Preference, acceptability and implications of the rapid hepatitis C screening test among high-risk young people who inject drugs. BMC Public Health. 2014 Jun 25;14:645.