Hep C Self-Testing

Is simple, reliable testing at home a step towards elimination?

Imagine being able to test yourself for hepatitis C in the privacy of your home, just like a pregnancy test. Would you be more ready to take the test? New diagnostic tools are being developed and piloted for hepatitis C self-testing in selected countries around the world. Findings were recently presented at a webinar by Sonjelle Shilton, Deputy Head of HCV, Access at the Foundation for Innovative New Diagnostics (FIND). The meeting was organised by the World Health Organization’s (WHO) Western Pacific Regional Office (WPRO). WHO hepatitis testing guidelines describes selftesting as “a process in which an individual who wants to know his or her status collects a specimen, performs the test and interprets the result themselves, often in private.” It goes on to say that HIV selftesting which is now conducted in many settings is highly acceptable in a variety of groups and its availability has increased uptake of testing among people not reached by other HIV testing services, many of whom are first-time testers. Based on this, hepatitis C selftesting (HCVST) is seen as a potentially important way to expand access to hepatitis C testing. The FIND-WHO pilot of HCV self-testing tools was carried out in 10 countries covering a total of 22 sites. The tests included one using oral fluid and another using small blood samples. Five sites trialed both methods, 13 did only oral fluids and four sites used only the blood-based method (see map, below). This pilot is a feasibility study looking at usability and acceptance of these selftesting tools among people who inject drugs (PWID) and men who have sex with men (MSM). Some countries, like Georgia and Malaysia, integrated the hepatitis C self-testing tests into existing HIV self-testing platforms. In Pakistan, the pilot hepatitis C self-tests were integrated into an existing doorto-door campaign for a micro-elimination program targeting the general population in a district in Karachi.

Results from the study indicated high acceptability of the hepatitis C self-testing tools in six countries. In China lower acceptability was observed in the MSM population—many participants were not confident of the test results and did not consider themselves at risk of hepatitis C. Where there was in-person demonstration given beforehand, participants made very few mistakes in carrying out the steps, and most people interpreted the results correctly. A vast majority of the self-test results agreed with those from professional use tests (see table, above). In trials where participants were not given an in-person demonstration beforehand, a majority of participants nonetheless performed the tests correctly. While unassisted self-testing led to more frequent mistakes, the mistakes did not have a major effect on test results. Participants with a higher educational level were able to carry out the tests with less mistakes. The study suggested that in-person demonstrations in target populations with less formal education, at least in the initial stages, would be one way to ease the tests in and reduce mistakes. The tests used in this pilot study are not yet available on the market. In her presentation, Sonjelle Shilton pointed out that these hepatitis C self-tests only detect antibodies and are not meant to replace existing hepatitis C tests. They are a first step for people to find out if further tests are needed to confirm their hepatitis C status. From a regional perspective, countries in the Western Pacific have high rates of hepatitis C infection and deaths and, discounting Australia and New Zealand, low rates of diagnosis and treatment uptake. Reliable, easy to use self-testing tools could be one way to boost diagnoses and help countries move towards hepatitis C elimination. v