6 minute read
Rapid Hep C Testing
Rapid Results
HCV Rapid Testing Clinics using the GeneXpert Machine
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Commencing in October 2020, the Hepatitis SA HCV Peer Information and Support Workers have been assisting with testing for hepatitis C in the community using rapid testing.
Our first experience with rapid testing was involvement in the PROMPt research study, whereby our Peers provide support to the Clinical Nurses at the Adelaide Remand Centre, DASSA Inpatient Withdrawal Services, Glenside Rural and Remote Ward and, more recently, at Hutt Street Day Services for people experiencing homelessness.
Since November 2021 the Viral Hepatitis Nurses have also had access to a portable GeneXpert machine.
SA Health has acquired the GeneXpert machine to help increase testing rates for hepatitis C, in order to reach the Australian Government’s goal to eliminate hepatitis C as a public health threat by 2030. This method of testing is conducted with just a fingerstick blood test and provides a result in less than an hour! This means that traditional blood samples taken by needle and syringe are not required to diagnose a person’s hepatitis C status, making it easier to test people with difficult veinous access or for those who have a chaotic lifestyle which puts hepatitis C testing low on their list of priorities.
GeneXpert testing for hepatitis C is TGA-approved and will identify whether someone has a current hepatitis C infection that requires treatment. It takes about 10 minutes to provide pre-testing information and take a sample. We then call the participants about an hour later with their results, and to also arrange followup testing or treatment, as required.
Hepatitis C is preventable, treatable, and curable, with just a course of daily tablets for 8 or 12 weeks. It is critically important to diagnose and treat hepatitis C early to avoid the risk of serious liver disease, including liver failure, cirrhosis, liver cancer and further transmission.
This manner of testing is extremely portable. All we require to conduct the testing is a private room with a desk or table, two chairs and a powerpoint to plug the machine in. The GeneXpert machine is a cube approximately 40cm wide (see opposite page), and has the capacity to run four samples at a time. As each sample completes (after an hour), a new sample can be put in for testing. The samples can be kept in the cartridges for up to four hours before running the tests, but the contents must not be disturbed, or the test will fail. This meant that what we did on the Viral Hepatitis Nurses’ first day of having access to the machine, is likely a world first!
The Viral Hepatitis Nurses had a patient referred to them for hepatitis C testing. The person was bedridden and awaiting surgery. The nurses had been informed that the surgeon would not do the surgery without a hepatitis C RNA test (this may or may not have been true). It was explained to me that various nurses had attended her home more than once to collect blood by the usual needle and syringe method for testing. This was not successful for several reasons, including patient resistance and difficult veinous access. Knowing that if we could just retrieve a fingerstick sample of blood from this patient—we transported the sample, holding on to it like a human shock absorber in the car along the way, and ever so carefully from the car back to the office where the machine was—we might just get the result required. We did this ever so tentatively, knowing that the sample is vulnerable and will not run without errors if the temperature of the cartridge is over 28°C or is shaken even slightly. You may wonder why we didn’t take the machine to the person? As it happened, we would not have had anywhere to plug the machine in, and would have then had to stay a full hour in this person’s home, which was less than an ideal setting for this activity. The great news is that we let the sample settle for a while and then started the test. To our surprise we were able to give our client, and the referring surgeon, the result that day! It was good news for all. This was a highly unusual circumstance (and will not be offered as standard procedure), but it really highlights the wonderful benefit of a fingerstick test over traditional testing.
In the short time since we began using the mobile GeneXpert and fingerstick method of testing, the benefits have been highlighted again and again!
We have attended OST pharmacies and Community Corrections sites with the machine, and found people that had been lost to followup—not because they’d been avoiding treatment, but because it just keeps getting put to the bottom of their list of priorities.
Another person said to me that they thought they had been at risk of hepatitis C transmission when they commenced injecting, before being in control of their own sterile equipment and mix, but they would never disclose to a GP that they had been at risk of contracting hepatitis C for fear of being treated differently. They were extremely grateful and relieved to be informed, in just one hour from test to result, that they did not require treatment.
We have met others along the way that have avoided their post-treatment test due to the difficulty of getting a sample from their veins, and some who have told us that they thought they had been reexposed but were told that the treatment was so expensive that they only get “one shot” at it. It is very rewarding to be able to be a part of putting their minds at ease and informing them that we are so lucky in Australia that anyone who needs treatment is able to access it and be cured!
The fingerstick test for hepatitis C will be available in 2022 in a variety of locations, including regular days at the Adelaide Remand Centre and the Hutt St Day Centre. Call us on 8362 8443 for details or check our website for notices.
