PROMPt Testing

Rapid, easy, needle-free hepatitis testing

Suppose for a moment that you are one of thousands of people around the world each year who confront the possibility that they may have contracted the hepatitis C virus. You’re worried, perhaps confused, and have a million other things on your mind. Where do you start? You’ll need a blood test, so you go to a GP, only to find you need to make another appointment—usually at another location—to have the blood test done. And then, after an agonising wait (an average of a week), you go to another appointment with the GP to find out the result. If you discover you have hepatitis C antibodies, you’ll need to go through this process again—blood test, then return to the GP for the result—to find out if you have a hepatitis C infection. This is because antibodies tell us if you’ve had the virus in your body, but don’t tell us if you have a current infection. Although interferon-based treatments have thankfully been displaced by effective, short-term and very tolerable oral therapies, there are still significant obstacles to hepatitis C treatment in Australia. Described above is the process to determine a person’s hepatitis C status under Medicare rules, and it is no wonder that many people don’t make it to the final appointment to find out their diagnosis: life just gets in the way! If you’re a person who finds blood tests difficult and the thought of needles makes you go dry in the mouth, it’s possible you might not even make it to the first blood test for a very long time if at all. Imagine if all of these encounters could be compressed into a single appointment: a person could have a test with blood taken from a finger prick rather than a needle, get the result, and be prescribed treatment for hepatitis C all in one visit to their healthcare provider. The PROMPt study aims to make this a reality in three locations across Adelaide during a 12-month trial period. With generous funding from the Paul Ramsey Foundation and with support from the Burnet Institute, PROMPt is a collaboration between multiple stakeholders that includes SA Health, Hepatitis SA, Serco Asia Pacific, the Department for Correctional Services, Mental Health Services and Drug and Alcohol Services SA. Two rapid tests are used in the project: the SD Bioline hepatitis C antibody test and

the Genexpert hepatitis C viral load test* . The antibody test doesn’t require any special machinery, and takes a minimum of 5 minutes to process. It works similarly to other rapid tests, like pregnancy tests. One line indicates a negative result, with two lines indicating a positive. Although this test doesn’t yet have TGA approval for use in Australia, it’s highly accurate, used widely overseas, and PROMPt has special permission to use it. If antibodies are detected with the presence of two lines, the hepatitis C viral load test needs to be done to find out if a person has a current infection. This is because, as mentioned above, antibodies can’t tell us whether or not a person has a current infection, only that their body has had to fight the hepatitis C infection at some stage in their life (perhaps years earlier), and their immune system has created antibodies in the process. The hepatitis C virus test is run in a small mobile laboratory unit that needs

* For more on these and other rapid hepatitis tests, see our previous issue.

ABOVE: the SD Bioline kit for finger prick test kit BELOW: the Genexpert analysis machine

power and takes just under an hour to get a result. Both tests require a small sample of blood taken from a finger prick, using the same kind of lancet that people with diabetes use to test blood sugar. As no needles are used, one of the aims of the study is to find out if the finger prick testing method increases the number of people who opt to get tested for hepatitis C in the locations where the study has been implemented. Weekly testing sessions have been held in a prison, a mental health unit and a drug and alcohol withdrawal unit since October last year, with a nurse and experienced peer educators from Hepatitis SA. The peer educators conduct the testing and share their life experiences with hepatitis C and treatment with the clients through short 10- to 15-minute encounters. So who can be part of this trial? Anyone who is staying in one of these facilities can volunteer, and there are no special criteria for testing. People come up for testing for all sorts of reasons and it’s through sharing these with the PROMPt team that opportunities for education often arise. Feedback from participants has been positive, including one who said, “A lot of users don’t have veins, so a prick of the finger is nothing. I was recently tested and they took three or four times until they got blood. I don’t want hep C again, I want a healthy life!”. Another person told us, “I get anxiety really bad, so if I’ve got hep C I want to know now so I can deal with it.” Most people who discover they have a current infection commence hepatitis C therapy within a few weeks after diagnosis with assistance from the PROMPt team. So far, over 700 people have participated in testing that will continue until the end of October this year. The PROMPt team are grateful to everyone who has participated in this research project and generously shared their stories with us. v

PROMPt

Lucy Ralton Nurse Consultant