Wong NS, Chan DPC, Chan CP, Poon CM, Wong GLH, Wong VWS, Lee SS. Point-of-care hepatitis C reflex testing and treatment referral in methadone clinic settings in Hong Kong—a pilot study.
IJID REGIONS 2022;
5:8-12. [PMID:
36119439 PMCID:
PMC9471432 DOI:
10.1016/j.ijregi.2022.08.007]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 12/04/2022]
Abstract
Hepatitis C virus (HCV) prevalence is high among attendees of methadone clinics in Hong Kong.
Finger-prick sampling and reflex HCV testing constitute an acceptable strategy.
Linkage of RNA-positive methadone clinic attendees to direct-acting antiviral treatment referral is high.
Methadone clinics could be enabled to contribute to HCV micro-elimination.
Objectives
People who inject drugs (PWID) constitute a population group with a high hepatitis C virus (HCV) burden. With the objectives of assessing the HCV prevalence in PWID and determining the proportion requiring treatment who could be linked to care, this study piloted onsite reflex HCV testing at low threshold methadone clinics, with prompt referral of HCV RNA-positive participants for treatment.
Methods
This was a prospective study on methadone clinic attendees in Hong Kong. Questionnaires were completed, finger-prick anti-HCV rapid testing was performed, and positive blood samples were collected for laboratory HCV RNA testing. The proportions of participants along the cascade of HCV care were calculated.
Results
In 2021–2022, after 14 evening screening sessions at three methadone clinics, 86 of 354 regular attendees (24%) were recruited. The anti-HCV prevalence was 63% (54/86, 95% confidence interval 52–73%), with 78% (42/54) testing positive for HCV RNA and 79% (33/42) successfully referred. Almost all (31/33) referred participants received direct-acting antiviral (DAA) treatment, 94% (29/31) with full treatment compliance; 55% (16/29) of these compliant participants achieved a sustained virological response, while the remainder had not received post-treatment testing.
Conclusions
The use of a simplified testing algorithm in the setting of substitution treatment services, incorporating reflex HCV testing, could be an effective strategy for contributing towards the micro-elimination of HCV in PWID.
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