A study by Dr. Pai and her team points out that new rapid and point of care hepatitis C tests could be global game changers.
Although conventional lab testing is in place in developed countries, it is available only to those who visit community clinics and specialized hospitals and have a risk profile, or symptomatology, that warrant screening. Typically, results are available within a week, but may only be communicated to the patient during their next visit, which may be one to three months later. Delays like this may result in reduced patient follow-up and potentially impact transmission of the virus in the community.Accurate and reliable point-of-care tests and rapid tests offer an alternative to standard tests. “First generation point-of-care tests are convenient, effective and informative for clinical decision making,” explains Dr. Pant Pai. “These tests usually don’t require specialized equipment, they can provide results within 30 minutes, or maximally within one patient visit or one working day, and many do not require electricity,” adds Sushmita Shivkumar, lead author of the study and a medical student at McGill University. More than 170 million people are infected with hepatitis C worldwide due to unsafe blood transfusion, injection drug use and unsafe therapeutic injections. Hepatitis C and HIV co-infections contribute substantially to disease burden in North America, but the affect of the disease is highest in Africa and Asia. “With promising oral drugs for Hepatitis C on the horizon, accurate and reliable point-of-care and rapid tests will allow millions of infected individuals worldwide to be diagnosed and treated,” explains the study’s co-author Dr. Rosanna Peeling, Professor and Chair of Diagnostics Research at the London School of Hygiene & Tropical Medicine
The World Health Organization estimates (1) that 170 million persons worldwide are infected with the hepatitis C virus (HCV). Developing countries in Africa and Asia report the highest prevalence of this virus, which is transmitted predominantly by unscreened blood transfusions, injection drug use, and unsafe therapeutic injections (2). Because HCV and HIV infections share similar routes of transmission, about 40% of HIV-infected persons are co-infected with HCV (3). The prevalence of HIV–HCV co-infection varies from 16% to 33% in injection drug users in North America to 50% in Brazil (2,4). Morbidity and mortality are also higher in co-infected populations (5 – 8). Chronic hepatitis C infection is associated with long-term complications, such as liver fibrosis, cirrhosis, and hepatocellular carcinoma (1). Although newer treatments for hepatitis C (such as telaprevir or boceprevir with pegylated interferon and ribavirin) have made viral suppression a possibility, timely screening is critical to the success of these newer treatments (9). In addition to the high burden of co-infection, marginalized at-risk populations face social, structural, and economic barriers, such as limited access to testing (10) and lapses in health insurance (11), which hamper early screening and timely engagement with care.
About this study
The study, Accuracy of rapid and point-of-care screening tests for hepatitis C: A systemic review and meta-analysis, was authored by Sushmita Shivkumar (Clinical Epidemiology and McGill Medical School); Rosanna Peeling (London School of Hygiene and Tropical Medicine, UK); Yalda Jafari (Clinical Epidemiology, Department of Medicine, MUHC); Lawrence Joseph (McGill University/ RI MUHC) and Nitika Pant Pai (McGill University/RI MUHC).
Partners in research
This work was supported by funds from Canadian Institutes of Health Research.
- McGill University Health Centre (MUHC): muhc.ca
- Research Institute of the MUHC: muhc.ca/research
- McGill University: mcgill.ca
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