Point-of-care (POC) hepatitis C virus (HCV) RNA viral load testing vs laboratory-based standard-of-care (SOC) is associated with a faster turnaround time from antibody assay to treatment initiation and an increase in treatment uptake, according to study results published in The Lancet Gastroenterology & Hepatology.
Loss of follow up to care and treatment has been linked to the SOC diagnostic strategy, which entails laboratory-based testing that can be limited in many low- and middle-income countries. The alternative, POC assays, have led to faster therapy initiation and treatment monitoring for patients with HIV and tuberculosis. Due to no previous research regarding HCV, researchers sought to compare the effects of POC vs SOC assays for HCV viral load testing and treatment uptake.
Researchers conducted a systemic review and meta-analysis, searching for observational and randomized controlled trials that used POC HCV viral load assays with or without a comparative SOC assay. The POC HCV viral load assays were categorized according to whether or not the POC assay was used onsite or in a mobile unit. Population types included those who injected drugs, were homeless, or incarcerated in prison. For each POC and SOC group, studies were further designated into different models of care according to number of sites and visits needed to satisfy initial testing and treatment initiation. Studies with 10 or fewer participants irrespective of treatment type assay were excluded.
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In total, 45 observational studies were used to quantify outcomes along the treatment spectrum, notably HCV viral load testing and treatment uptake, as well as turnaround times. Researchers found that median turnaround time from HCV antibody testing and treatment initiation was reduced with the use of onsite POC assays (weighted median of medians 19 days [95% CI, 14-53]), compared with laboratory based POC assays (64 days [64-64]) or laboratory based SOC assays (67 days [50-67]). There was also an overall increase in treatment uptake using onsite (77% [95% CI, 72-83]) or mobile POC assays (81% [60-97]) compared with SOC assays (53% [31-75]). The majority of those that used POC viral load assays included individuals who injected drugs, were homeless, or both (a significant portion of the affected population). A simplified care model in which testing and treatment were done at the same site also showed greatest impact in regards to POC viral load.
Limitations include the absence of randomized controlled trials that included a direct comparison of POC assays and laboratory-based SOC assays. Therefore, overall risk-of-bias rating is high.
“The effect of POC viral load testing is greatest when positioned within a simplified care model in which testing and treatment are provided at the same site, and, where possible, on the same day,” the study authors noted. “POV HCV RNA viral load testing is now recommended in WHO guidelines as an alternative strategy to laboratory-based viral load testing.”
Reference
Trickey A, Fajardo E, Alemu D, Artenie AA, Easterbrook P. Impact of hepatitis C virus point-of-care RNA viral load testing compared with laboratory-based testing on uptake of RNA testing and treatment, and turnaround times: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2023:8(3):253-270. doi:10.1016/S2468-1253(22)00346-6.
This article originally appeared on Gastroenterology Advisor
