Simultaneous Human Immunodeficiency Virus-Hepatitis B-Hepatitis C Point-of-Care Tests Improve Outcomes in Linkage-to-Care: Results of a Randomized Control Trial in Persons Without Healthcare Coverage

Julie Bottero, Anders Boyd, Joel Gozlan, Fabrice Carrat, Jean Nau, Marie-Dominique Pauti, Hayette Rougier, Pierre-Marie Girard, Karine Lacombe, Julie Bottero, Anders Boyd, Joel Gozlan, Fabrice Carrat, Jean Nau, Marie-Dominique Pauti, Hayette Rougier, Pierre-Marie Girard, Karine Lacombe

Abstract

Background. In Europe and the United States, more than two thirds of individuals infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and 15%-30% of human immunodeficiency virus (HIV)-positive individuals are unaware of their infection status. Simultaneous HIV-, HBV-, and HCV-rapid tests could help improve infection awareness and linkage-to-care in particularly vulnerable populations. Methods. The OptiScreen III study was a single-center, randomized, control trial conducted at a free clinic ("Médecins du Monde", Paris, France). Participants were randomized 1:1 to receive 1 of 2 interventions testing for HIV, HBV, and HCV: standard serology-based testing (S-arm) or point-of-care rapid testing (RT-arm). The main study endpoints were the proportion of participants who became aware of their HIV, HBV, and HCV status and who were linked to care when testing positive. Results. A total of 324 individuals, representing mainly African immigrants, were included. In the S-arm, 115 of 162 (71.0%) participants performed a blood draw and 104 of 162 (64.2%) retrieved their test result. In comparison, 159 of 162 (98.2%) of participants randomized to the RT-arm obtained their results (P < .001). Of the 38 (11.7%) participants testing positive (HIV, n = 7; HBV, n = 23; HCV, n = 8), 15 of 18 (83.3%) in the S-arm and 18 of 20 (90.0%) in the RT-arm were linked-to-care (P = .7). In post hoc analysis assuming the same disease prevalence in those without obtaining test results, difference in linkage-to-care was more pronounced (S-arm = 60.0% vs RT-arm = 90.0%; P = .04). Conclusions. In a highly at-risk population for chronic viral infections, the simultaneous use of HIV, HBV, and HCV point-of-care tests clearly improves the "cascade of screening" and quite possibly linkage-to-care.

Keywords: HIV; linkage-to-care; point-of-care rapid test; screening; viral hepatitis.

Figures

Figure 1.
Figure 1.
Study flow diagram. Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Figure 2.
Figure 2.
Screening access, human immunodeficiency virus-hepatitis B virus-hepatitis C virus (HIV-HBV-HCV) awareness and linkage to care per testing arm. The proportions of patients from initial screening to linkage-to-care are provided for those randomized to either standard serology (S arm) or rapid testing (RT arm). Patients are stratified by infectious disease status after screening.
Figure 3.
Figure 3.
Main steps of the cascade of screening. In this figure, the steps needed to appropriately screen individuals for human immunodeficiency virus, hepatitis B virus, or hepatitis C virus are elaborated in detail, as they apply to the French healthcare system.

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Source: PubMed

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