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The National Australian HCV Point-of-Care Testing Program

The challenge

Direct-acting antiviral hepatitis C virus (HCV) therapies is one of the greatest medical advances in decades and has led to a major reversal in liver-related mortality. Yet despite this, treatment uptake in Australia declined rapidly between 2016 and 2020. While improving HCV treatment uptake is a key aim of global, national and state-based HCV strategies, this can’t be done without removing barriers to testing which exist in the current method of testing. Currently, testing and diagnosis is a long and drawn-out process requiring multiple visits to a health practitioner. An alternative approach is needed to scale-up HCV testing and treatment in Australia.

The project

The Kirby Institute, UNSW Sydney and the International Centre for Point-of-Care testing at Flinders University have been funded by the Commonwealth Department of Health to establish a National Australian Hepatitis C Point-of-Care Testing Program, consisting of a network of sites to scale up point-of-care HCV testing in settings providing services to people at high risk of acquiring HCV infection.

This program will provide sites with standard operating procedures, extensive technical training, participation in a quality assurance program as well as access to point-of-care finger-stick HCV tests for both HCV antibody and HCV RNA.

The method

The program has established an observational cohort to evaluate whether scale-up of finger-stick point-of-care HCV testing increases diagnosis and treatment uptake for HCV infection. Participants will be recruited from settings providing services to people with high risk factors for acquisition of HCV infection (including drug treatment clinics, needle and syringe programs, homelessness settings, mental health services, prisons, mobile outreach, and Aboriginal Community Controlled Health Organisations). Participants will attend a single visit to have their HCV RNA status investigated and complete a self-administered survey. Participants who are HCV RNA positive will be linked to standard of care. Participants will also provide consent for their information to be linked to administrative data.

The impact

This program is among the first internationally to evaluate scale up of point-of-care HCV testing on treatment uptake among people at-risk of HCV in a range of different healthcare settings, providing critical information on this approach towards reducing HCV prevalence. Findings from this program will continue to identify facilitators and barriers to testing, scale-up and treatment uptake and in turn, informing the feasibility of future HCV point-of-care testing scale-up in other global settings. Given the strong collaborations between stakeholders, this program will facilitate the translation of research outcomes to practice and policy, informing national and international clinical and regulatory guidelines, health service implementation, hepatitis strategies, and health policy.

Project collaborators

Abbvie; ACT Government; Australian Government Department of Health; Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM);Canberra Alliance for Harm Minimisation and Advocacy (CAHMA); Cepheid; Clinical Universe; Communicable Disease Control Branch; South Australian Department for Health and Wellbeing, Drug and Alcohol Services South Australia; Gilead Sciences; Harm Reduction Victoria; Hepatitis Australia; Hepatitis ACT; Hepatitis NSW; Hepatitis QLD; Hepatitis SA; Hepatitis WA; International Centre for Point-of-Care testing at Flinders University; LiverWELL (incorporating Hepatitis Victoria); Metro North Health Queensland Health; Mid North Coast Local Health District; National Aboriginal Community Controlled Health Organisation (NACCHO); National Serology Reference laboratory (NRL); Northern Territory AIDS and Hepatitis Council (NTAHC); NSW Health; NSW Health Pathology; NSW Users and AIDS Association (NUAA); NT Health; Queensland Health; Queensland Injectors Health Network (QuIHN); South East Sydney Local Health District; St Vincent’s Hospital Sydney Limited; The Australian Injecting and Illicit Drug Users League (AIVL); The Tasmanian Council on AIDS, Hepatitis, & Related Diseases (TasCAHRD); VIC Health.

Project funding

NHMRC Partnership Grants (2013921); NSW Health; Giliead Sciences; Abbvie.