ENGAGING THE DISENGAGED: HCV SELF TESTING AND LINKAGE TO CARE FOR DTS CLIENTS DURING COVID

ABSTRACT

Introduction Home self-testing has been validated for HIV with evidence for increased uptake, comparable linkage to care and an absence of harm in those at risk. However, there are limited data on this strategy for people at risk of HCV infection (WHO 2021). Surrey HCV ODN Drug and Alcohol services (iAccess & Inclusion) provide a range of interventions including structured treatment for people with a history of alcohol or substance misuse. During COVID most clinics moved to telephone consultations, reducing BBV screening opportunities. This project targeted service users with > 12 months follow up for reengagement with HCV testing through supported home self-testing for HCV with rapid linkage to care through the ODN. Methods Interrogation of the EPR at the DTS (iAccess and Inclusion) identified a target population of older clients (>45years) who had not previously engaged with the offer of HCV testing. Exclusion criteria previous positive HCVAb result, prior HCV treatment, negative DBS test within 6 months. Initial telephone contact from the hepatology CNS, Hep C Trust peer or Drug service recovery worker to was used to explain the project in detail and gain consent for participation. Participants received a postal testing pack including bespoke patient information leaflet and Oraquick® point of care test. The team used a dedicated phone number to discuss results and deliver support. Positive HCV Ab tests triggered an urgent assessment by the hepatology CNS supported by Hep C Trust peers. Results Preliminary results are available for the first six months (completion planned May 2022). Across the network 210 people agreed to participate and received home HCV self-test kits. 92 reported test results (44% of postal tests dispatched). Six HCVAb+ 80 HCVAb-, six test failures. 6.5% of completed tests detected HCV Ab. Of the six HCVAb+ identified to date five have attended for confirmatory PCR in the ODN. Two of five were PCR negative (spontaneous clearance), two PCR positive patients have commenced treatment and one awaits additional diagnostics. The strength of the ODN linkage to care processes is reflected in the client pathway, including two patients who were subsequently incarcerated and followed up by the ODN prison in reach team. Conclusions Postal testing for HCV using a rapid point of care test is feasible and provides an opportunity to engage at risk individuals for HCV testing. Once engaged linkage to care was effective utilizing the ODN network. This approach has also provided a useful avenue for HCV diagnosis and the care cascade during the pandemic when many clinic assessments have been managed remotely.