Point-of-care Testing in COVID 19 Vaccination centres
A point-of-care (POC) testing pilot to improve hepatitis C virus (HCV) diagnosis and linkage to care in Lombardy, delivered under the supervision of the Lombardy Regional Government. Free HCV testing was offered at four hospital-based COVID-19 vaccination hubs, with the support of their resident hepatologist centres, for people born between 1969 and 1989.
Just after being vaccinated against COVID-19, individuals were offered the opportunity to test for HCV and receive results during the 15-minute post-vaccination observation. Whilst lower than expected HCV prevalence among the target population was revealed, it proved the feasibility of this model of opportunistic testing, hence encouraging implementation with other age cohorts (i.e., people born before 1969).
Italy is considered one of the European countries with the largest burden of HCV. Prevalence estimates range from 1.1% to 22.4%, and higher incidence is reported among the aged population in the South. Despite progress in diagnosing and linking people to care, the majority of individuals infected (around 200,000) remain unaware of their condition and are not receiving life-saving treatment. Worryingly, COVID-19 disrupted HCV diagnosis, prevention and treatment services, to the extent that Italy was no longer on track to meet the WHO elimination goals. Against the backdrop of the pandemic, this project was launched as part of a series of measures by the Italian Government to improve HCV screening among key populations (i.e., the 1969-1989 population cohort, people who inject drugs and prison inmates) to address COVID’s impact on progress towards elimination.
To leverage the vaccination programme, a preliminary study was conducted to assess the feasibility of such a project by the hepatologist centres due to provide support. These centres had been selected for (1) having a hub for COVID-19 vaccination at their hospital, (2) being an expert Centre for HCV management and treatment and (3) having regional authorization for DAA prescription. Once the project was authorized, it envisaged up to 75,000 HCV tests of finger stick blood type (i.e., In Tec Advanced Quality® Rapid HCV Antibody Test and Anti-HCV WB/S/P). Individuals born between 1969 and 1989 who had come to any of the hubs for their COVID-19 vaccination were, after being vaccinated, offered a leaflet inviting them to test for HCV and receive results during the 15-minute post-vaccination observation. Those who tested positive were referred to outpatient clinics to confirm their testing and initiate treatment.
From the 50,000 individuals who visited the vaccination hubs, 22,584 belonged to the target population, 7,925 received the leaflet and 7,219 (91%) agreed to test for HCV. Up to 0.1% (7) tested positive, the majority being males (5) in their mid-40s, and from a migrant origin in all cases but one. The majority (57%) was confirmed chronically infected with hepatitis and linked to care, and only one person was lost to follow up. Overall, the four hubs spent a median of 30 hours handing out leaflets and performing tests, with doctors and nurses taking an average of 3.5 and four minutes for test, respectively.
Learnings and Recommendations
Despite the lower-than-expected prevalence of HCV in those born between 1969 and 1989, this project demonstrated the feasibility of POC testing strategies for HCV at COVID-19 vaccination hubs. The high acceptance rate (91%) is particularly noteworthy and should encourage implementation in additional age cohorts. Still, the financial aspect and logistical issues as regards human resources, should be considered.
Massimo Colombo, EASL International Liver Foundation