Reflex testing, the practice of automatically testing
hepatitis C antibody-positive blood samples for hepatitis C virus (RNA
testing), eliminates the need for a person who tests positive for antibodies to
be recalled for further testing. Reflex testing increases the rate of diagnosis
of chronic hepatitis C infection. Implementation of reflex testing is practiced
widely in Spain.
Alternative diagnostic methods to help people move from
hepatitis diagnosis to cure are also needed, especially point-of-care tests that
can give results within 20 minutes or an hour. Again, these can eliminate the
need for multiple visits and blood draws, for example through siting the Gene
Xpert RNA testing platform in drugs services. Testing for hepatitis C core
antigen can eliminate the need for confirmatory RNA testing, while dried
blood spot sampling allows screening in people with poor venous access or where
trained personnel are not available to carry out blood draws. Dried blood spot
sampling has been used extensively for hepatitis C screening in the United
Kingdom, France and the Netherlands.
Electronic medical record reminders to screen for hepatitis
C can improve screening rates, using age cohort reminders to screen
older patients in the United States or risk-based reminders to screen people
with hepatitis C risk factors.
Decentralised and community-based testing in drugs
services not only improves diagnosis but leads to increased engagement in
treatment, the review found. Similarly, offering testing in migrant facilities
and internment centres can enable engagement in treatment, Italian and Australian
models show. Very large-scale community-based testing in Egypt resulted in testing
of almost 80% of the population in 2018 and 2019, the reviewers note.
Testing in community pharmacies using dried blood
spot testing has achieved high testing uptake among people who inject drugs in
London and Scotland and was more likely to result in hepatitis C screening compared
to the conventional testing pathway in a Scottish study in people receiving
opioid substitution therapy. Mobile testing services, for example
through vans which go to locations where they can reach homeless people, drug
users and sex workers, have proved successful in Australia, Denmark, Spain and
the United States.