Point-of-care testing to diagnose hepatitis C virus (HCV) infection has the
potential to eliminate the need for multiple appointments to confirm chronic
infection. An oral antibody test can provide a result in 20 minutes. For those
who test antibody positive, a viral load test (Xpert HCV Viral Load) on a blood
sample drawn by venepuncture can provide confirmation of chronic infection in
around two hours.
Would point-of-care testing be acceptable to people who
inject drugs? Improving the uptake of testing and engagement in care of people
who inject drugs is critical for elimination of hepatitis C. The need for
multiple appointments and visits to unfamiliar healthcare facilities has been
identified as a barrier to care for people who inject drugs, whereas
point-of-care testing has the potential to engage people at community-based
testing sites such as needle and syringe programmes.
To investigate the testing preferences of people who inject
drugs, researchers from the Burnet Institute in Melbourne carried out a pilot
study of point-of-care testing at needle and syringe programmes in the city. A
qualitative study interviewed 19 people who had undergone point-of-care testing
to learn more about the acceptability of it.
Study participants were predominantly male (74%), with a
median age of 44 years. All had injected drugs in the previous month, with a
median of 28 injecting episodes during that period. Fifteen of 19 tested
positive for HCV antibodies and six were RNA positive on a viral load test.
Although none reported sharing needles or syringes in the
preceding six months, sharing of injecting equipment such as spoons, filters
and water was reported by a substantial minority (for example, 37% reported
that they had shared a spoon with others after using it themselves, so-called
Participants valued the fact that testing was carried out by
needle and syringe programme staff who were not judgemental.
They also preferred mouth swab collection of oral samples
for antibody testing.
“It’s like less hassle …getting blood sounds really intense,
but doing a mouth swab, sounds really nonchalant …I’d come every week if that’s
all it was,” said a 21-year-old user of the service.
Some participants valued the fact that they were permitted
to take a blood sample themselves, after bad experiences in other healthcare
settings of trying to obtain blood from damaged veins.
Although finger-stick sampling of blood for RNA testing is
possible, most participants said that the ability to test a venous blood sample
for other blood-borne viruses meant they preferred to give a venous sample. They
also noted that venepuncture at the diagnosis visit would also allow
pre-treatment tests to be done, reducing the need for future blood sampling.
A 20 minute wait for an antibody test result was
acceptable to all participants but waiting two hours at the needle and syringe
programme for the result of an RNA test was considered too long to wait.
Participants would prefer to return later in the day to get their results, but
in fact, 10 out of 15 who underwent RNA testing did not get their result on the
same day and when questioned about the speed of receiving this result, some
participants said that they didn’t consider it urgent to find out the result,
as “you’re not going to die straight away”.