Point-of-care RNA testing: Can it close the gap in hepatitis C diagnosis?
Hepatitis C is a viral infection that can cause liver damage and scarring and make a person very sick if left untreated. Nearly one-quarter of people who have ever had hepatitis C in Canada are unaware of their status, so increasing testing remains pivotal if Canada is to eliminate hepatitis C as a public health threat by 2030. Many advances have been made over the past few years, and more tools are available than ever to test people for hepatitis C. Point-of-care RNA testing for hepatitis C is of particular interest to many service providers because it can be conducted outside of clinical settings and be used with populations that are sometimes hard to reach. CATIE spoke to Tamara Barnett, a registered nurse at Cool Aid Community Health Centre, to find out more about this technology and how it can benefit the landscape of hepatitis C diagnosis in Canada.
What is the point-of-care RNA test for hepatitis C and how is it administered?
The point-of-care RNA test uses blood taken from a finger prick to look for hepatitis C infection. The blood is dispensed into a cartridge that is loaded into a machine called the GeneXpert System, which provides results within 45 to 60 minutes. If the system detects hepatitis C virus, then the person will need hepatitis C treatment, which cures hepatitis C in eight or 12 weeks.
What’s the difference between an antibody test and an RNA test?
When the hepatitis C virus enters the body, the immune system makes antibodies against the virus which antibody tests can detect in the blood. Once a person has been exposed to hepatitis C, they will always test positive for antibodies, even after they have been cured with treatment or if they have cleared the hepatitis C virus on their own, which occurs in about a quarter of cases. A positive antibody test means the person has been exposed but is not necessarily infected, so antibody testing is only used as a screening test.
First, a hepatitis C antibody test tells us whether the person has ever been exposed to the virus. Second, a hepatitis C RNA test confirms whether the person is currently infected with the virus and requires treatment. If a person tests positive for antibodies but undetectable for RNA, that means they do not have a hepatitis C infection.
What does point-of-care mean?
Point-of-care refers to a test that does not require a laboratory for processing and can be performed outside of a clinical setting. There are many kinds of point-of-care tests. Most people are familiar with urine pregnancy tests, where the test is dipped into urine and the results are received within a few minutes. Since the COVID-19 pandemic, many Canadians are familiar with point-of-care tests due to the widespread availability of COVID-19 self-testing.
What is the advantage of the point-of-care RNA test for hepatitis C?
There are huge advantages to point-of-care RNA tests for hepatitis C as they provide results in under an hour and determine whether a person currently has hepatitis C. Because, point-of-care RNA tests only take blood from a finger prick, they reduce the need to draw blood from a vein. This is particularly helpful because standard blood draws can be challenging for people whose veins are difficult to access, which can be the case for people who inject drugs, a group particularly affected by hepatitis C in Canada. Standard blood samples also need to be sent to a lab and results can take days or even weeks depending on where you live. The point-of-care test greatly reduces the time it takes to receive a diagnosis and access treatment.
Point-of-care RNA testing can be conducted in locations where it is easier to reach communities most affected by hepatitis C, such as shelters, prisons, needle and syringe programs, primary healthcare clinics, pharmacies and drug treatment settings. Peers and non-medical service providers can be trained to administer point-of-care RNA testing, which allows people to be tested where they feel most comfortable and can help with linkage to care. It also reduces barriers caused by discrimination and stigma that groups affected by hepatitis C can encounter in traditional healthcare settings.
Where has the point-of-care RNA test been used in Canada?
Point-of-care RNA testing has mostly been used in research studies that focused on different models of delivering hepatitis C care, such as testing and treatment in pharmacies, outreach and mobile settings, as well as supervised injection facilities. In many of these studies, the point-of-care RNA test was used to decrease the amount of time it takes to get a diagnosis due to the difficulty in finding people and getting them their results using more traditional testing models.
What is holding us back from more widespread use of this testing technology?
We know that rapid, point of care hepatitis C RNA testing is being used successfully in many countries, including England and Australia, as well as in diverse settings such as prisons, mobile outreach and rural communities. While this technology is not yet approved by Health Canada, we anticipate that an approval may be coming soon. However, it may not be publicly funded so we will need to understand where investments in rapid hepatitis C RNA testing are most needed. Other countries have demonstrated benefits in prisons, mobile outreach and settings where people seek harm reduction services. However, to date, it’s not clear exactly where point-of-care hepatitis C RNA testing will fit into the Canadian healthcare landscape. What we do know is that it could be an important tool to ensure health equity and increase access to testing and diagnosis.
Tamara Barnett is a registered nurse with certified practice and has worked in many different areas including hemodialysis, peritoneal dialysis, sexual health clinics, women’s clinics, as a communicable disease nurse, and as a street outreach nurse. Tamara is currently working in primary care as the hepatitis C treatment coordinator of the nurse-led hepatitis C treatment program at the Cool Aid Community Health Center in Victoria, B.C. The Cool Aid clinic provides low-threshold primary care to vulnerable populations including people with polysubstance dependence and complex mental health challenges.
The Cool Aid hepatitis C program uses numerous innovative models of care including “seek and treat,” peer-led and pharmacy-led initiatives. Tamara is also currently working with the local jail developing a model of care for hepatitis C elimination with a link to primary care upon release from prison.