Molecular HCV Testing Feasible in Hospitals, but Participation Dips if HIV Mentioned

Anna Maria Geretti, MD, PhD

As public health officials look for ways to boost Hepatitis C virus (HCV) testing, a new study has shown it is now viable to offer molecular testing to patients in a clinical setting, such as an emergency department.

However, the results of the study also suggest that it matters how these tests are presented to patients.

A team of British researchers wanted to see if it was feasible to conduct highly accurate molecular testing in hospitals. To examine the question, they set up a pilot point-of-care testing program at an inner-city hospital in the United Kingdom for 4 months.

“Until very recently molecular testing was confined to the specialized laboratory, equipped with sophisticated infrastructure and equipment, and to be performed by highly specialized personnel,” said Anna Maria Geretti, MD, PhD, a professor of virology and infectious diseases at the University of Liverpool. “New and emerging platforms make it feasible for testing to be run near the patient, in settings that may reside within or outside of healthcare facilities (e.g. prisons).”

Geretti, the study’s first author, told MD Magazine the technology can be used to test a number of infectious diseases, but she said its impact could be particularly profound when it comes to HCV.

“These applications are especially relevant for hepatitis C due to the large number of undiagnosed carriers of the infection and the requirement for molecular testing to demonstrate that the infection is active,” she said.

For the study, adults who walked in to the emergency department with minor injuries were offered information about the importance of HCV testing and the benefits of early diagnosis. They were also given a questionnaire, which included demographic questions, questions about testing history, and an offer of either HCV testing or both HCV and HIV testing.

When the researchers analyzed the results, they found that the vast majority of patients (94.8%) returned the questionnaires when offered. A smaller, but still significant percentage (39.8%) accepted the offer of testing.

However, within that group, Geretti and colleagues noticed a significant divergence between acceptance rates when patients were offered HCV testing alone. When only HCV testing was offered, 46.8% of patients accepted. However, when patients were told they would be tested for both HCV and HIV, only 31.2% said yes.

Geretti said there’s insufficient data to say for sure why the offer of HIV testing corresponded to a lower acceptance rate, but she said it seems likely that it has to do with attitudes toward HIV.

“Whereas it is difficult to convey or quantify this scientifically our researchers’ feedback was that participants were not keen on discussing HIV testing,” she said. “Thus, yes, I do believe stigma and the fear of being identified as someone at risk of HIV infection had a role to play in this population.”

Geretti said while the most important finding of the study is that the testing technology is feasible in a point-of-care setting, clinicians and public health officials should also be cognizant that raising the spectre of HIV might have the unintended consequence of hurting HCV testing rates.

“The study does seem to point to the conclusion that the offer of the (HCV and HIV) tests should be dis-coupled,” she said. “Other venues of investigations should address the belief system that formed the barrier and how language around testing could be adapted to encourage uptake.”

Geretti said she and her team plan to expand their research in an effort to better understand what cultural and socioeconomic factors might be at play in testing acceptance rates.

The study, titled, “Point-of-Care Screening for a Current Hepatitis C Virus Infection: Influence on Uptake of a Concomitant Offer of HIV Screening,” was published in Scientific Reports.