POC Study Success
Positive outcome for PROMPt
PROMPt
A
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key barrier to hepatitis Participants were offered an 1 1, L. Ralton 1, J. Dawe 2, J.Richmond2, CC. (HCV) treatment is HCV diagnostic test using a Ferguson , E.M. McCartney the process of conventional quick5 fingerstick3antibody 6 1 J. Zobel3, A. Wigg4, V. Cock , E.Y. Tse , T. Rees , D. in Shaw the priority settings of testing that requires multiple (Ab) assay. Participants who behalf ofservices the EC Australia partnership were mental health, prisons and visitson to pathology tested HCV-Ab-positive AOD services. 1 Infectious providers and healthcare then offered a fingerstick Diseases Department, Royal Adelaide Hospital, South Australia, Australia HCV POC testing increased overall rates to obtain an HCV antibody HCV RNA assay run on the 2 Burnet Institute, Victoria, Australia of HCV testing as compared (Ab) test, an HCV RNA test, a GenXpert machine. 3 Gastroenterology & Hepatology Department, Royal Adelaide Hospital, South Australia, Australia to the previous 12 months of diagnosis, and then getting 4 Hepatology Department, Flinders Project staff, including peer Medical Centre, South Australia, Australia standard of care testing. linked5 to appropriate care to educators, Drug and Alcohol Services, South Australia,provided Australia HCV commence treatment. Combined HCV antibody education, andSouth post-test 6 Communicable Disease Control Branch, SApreHealth, Australia, Australia and RNA testing at the point A year ago (see issue 90, at bit. counselling, and linkage to of care has resulted in a ly/3xFCEp6), we covered the care at the time of diagnosis. significant testing scale-up at launch of the PROMPt project, Participants who tested HCV each service. which aimed to overcome RNA positive underwent critical roadblocks to HCV The researchers found post-test counselling, harm treatment by providing high acceptability of POC reduction education and Participant characteristics Total 1549. HCV point-of-care (POC) testing at each service. were linked to treatment. 83% (1,290) male,linkage 17% (256) female, 0.2% (3) other , median age 37 (30-46), Aboriginal/Torres Straitand testing and direct Working with site staff Linkage to care consisted Islander 25% (379) into treatment in the priority local viral hepatitis nurses of site staff being notified settings of mental health, was extremely effective in ofresults the positive HCV RNA N = 1,549. prisons alcohol other Table 1.and HCV Ab andand RNA POC test and RNA positivity facilitating HCV treatment. results, and participant drugs (AOD) services. PROMPt shows that this POC test outcomes Remand Prison Inpatient AoD Inpatient Mental Total details being sent to the approach Health Unit is an excellent PROMPt was run at several local viral hepatitis nurse for way to improve testing1549 rates sites in SA: the Adelaide HCV Ab test (n) 877 and treatment. 496 176 management and ensure people get the Remand Centre, at inpatient % Ab positive 17% (150/877) 19% (96/496) 10% (18/176) 17% (264/1549) The study results treatment and support they alcohol and other HCV RNA test (n) drug 150 96 18 264 demonstrate that it is feasible need if they are living with services, and at a mental % RNA positive 5% (39/877) 2% (10/496) 3% (6/176) 4% (55/1549) to provide HCV POC testing hepatitis C . v health inpatient unit.
Results
RNA positivity
26% (39/150)
10% (10/96)
33% (6/18)
21% (55/264)
Comparison of HCV rates between 12 months of standard Table 2. Comparison oftesting HCV testing rates betweenprevious previous 12 months of standard of careof care HCVtesting testing versus 1212 months of HCV testing HCV versus months ofPOC HCVintervention POC intervention testing Total Population
Total admissions HCV Ab tests HCV Ab positive HCV RNA tests HCV RNA positive %Ab positive RNA positivity Rate of Ab testing (Pi) Difference, (P2 – P1) [95% CI] P-value proportion test/population
Oct 2019 – Dec 2020 (Standard of Care testing) 6259 532 121 141 45 121/532 (22.7%) 45/141 (31.9%) 0.085 (8.5%)
(20.1 – 8.5) = 11.6% [0.104, 0.127] P <0.001
Table 3. Linkage to care outcomes N = 55 Linkage to care Remand Prison RNA positive, n
Oct 2020 – Dec 2021 (POC intervention testing) 7724 1549 264 264 55 262/1549 (16.9%) 55/264 (20.8%) 0.201 (20.1%)
Inpatient AoD Inpatient Mental Total June 2022 • HEPATITIS SA COMMUNITY NEWS 94 Health Unit
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