Background:
Globally, of the estimated 58 million people living with the hepatitis C virus (HCV), only 21% know their status. Scale-up of HCV testing is needed to close this diagnostic gap and aid in the achievement of the WHO 2030 elimination goals. There are currently no data on the real-world impact of HCVST. We evaluated the impact on uptake of HCVST compared to standard of care in 3 different HCVST models in Georgia, Malaysia, and Pakistan.
Methods:
Multiple modalities of HCVST were evaluated across the project countries. This included: 1) in Georgia: courier delivery of HCVST (for men who have sex with men [MSM]), peer delivery of HCVST (for MSM and people who inject drugs [PWID]), and the standard of care- referral to HCV-testing facility; 2) in Malaysia (for those who self-identify as a key population): courier delivery of HCVST, and standard care -referral to HCV-testing facility; 3) in Pakistan (general population): home distribution of HCVST or standard care of hospital-based HCV screening. To understand the relative impact in the different modalities of HCVST in HCV diagnosis, we evaluated the HCV care cascade for each subgroup in each modality of care compared to the standard of care.
Results:
In all 3 countries across all subpopulations, uptake of HCV Ab testing was higher in the HCVST groups compared to the control group (Table 1). Linkage to care was better in the HCVST arms as compared to the standard of care in Malaysia and Georgia for all sub populations and self-test modalities. In Pakistan, while the linkage to care was technically lower for self-test compared to standard of care, the total number of people successfully diagnosed was more than 10-fold greater. Results on uptake and linkage for HCVST compared to standard care did not differ significantly by sex.
Conclusions:
Across all HCVST modalities in all three countries, HCV testing uptake was greater with self-testing modalities as compared to the standard of care. Further to that, linkage to care was high across HCVST modalities. Careful consideration is needed for further scale-up of HCVST including; expected HCV Ab prevalence among target groups (affecting underlying cost-effectiveness of HCVST modalities), provision of tools to ensure testers are able to perform and interpret the test correctly, and mechanisms to facilitate psychosocial support and linkage to care.
Table 1: preliminary results across Georgia, Malaysia, Pakistan