Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
Department of Infection and Population Health, University College London, London, United Kingdom.
Sci Rep. 2018 Oct 17;8(1):15297. doi: 10.1038/s41598-018-33172-w.
Eliminating hepatitis C as a public health threat requires an improved understanding of how to increase testing uptake. We piloted point-of-care testing (POCT) for a current HCV infection in an inner-city Emergency Department (ED) and assessed the influence on uptake of offering concomitant screening for HIV. Over four months, all adults attending ED with minor injuries were first invited to complete an anonymous questionnaire then invited to test in alternating cycles offering HCV POCT or HCV+HIV POCT. Viral RNA was detected in finger-prick blood by GeneXpert. 814/859 (94.8%) questionnaires were returned and 324/814 (39.8%) tests were accepted, comprising 211 HCV tests and 113 HCV+HIV tests. Offering concomitant HIV screening reduced uptake after adjusting for age and previous HCV testing (odds ratio 0.51; 95% confidence interval [CI] 0.38-0.68; p < 0.001). HCV prevalence was 1/324 (0.31%; 95% CI 0.05-1.73); no participant tested positive for HIV. 167/297 (56.2%) POCT participants lived in the most deprived neighbourhoods in England. HCV RNA testing using finger-prick blood was technically feasible. Uptake was moderate and the offer of concomitant HIV screening showed a detrimental impact on acceptability in this low prevalence population. The findings should be confirmed in a variety of other community settings.
消除丙型肝炎对公共卫生的威胁需要更好地了解如何提高检测率。我们在一个市中心的急诊部试点了即时检测（POCT），以确定是否能提高丙型肝炎的检出率，并评估了同时提供 HIV 筛查对检测率的影响。在四个月的时间里，所有因轻伤到急诊部就诊的成年人首先被邀请填写一份匿名问卷，然后在交替的周期中被邀请接受 HCV POCT 或 HCV+HIV POCT 检测。通过 GeneXpert 在指尖血中检测病毒 RNA。共收回 814/859 份（94.8%）问卷，324/814 份（39.8%）接受检测，包括 211 份 HCV 检测和 113 份 HCV+HIV 检测。调整年龄和既往 HCV 检测因素后，同时提供 HIV 筛查使检测率降低（优势比 0.51；95%置信区间 [CI] 0.38-0.68；p<0.001）。HCV 患病率为 1/324（0.31%；95% CI 0.05-1.73）；无一人 HIV 检测呈阳性。297 名 POCT 参与者中有 167 人（56.2%）居住在英格兰最贫困的社区。用指尖血进行 HCV RNA 检测在技术上是可行的。检测率中等，同时提供 HIV 筛查对该低流行人群的可接受性产生了不利影响。这些发现应在各种其他社区环境中得到证实。
