A same day "test and treat" model for chronic HCV and HBV infection: Results from two community-based pilot studies in Egypt
Receipt of antibody results,Number new diagnoses,Linkage to care,Cost
Point-of-care antibody test (rapid test),Point-of-care PCR/RNA test
Prompt access to confirmatory viral load testing and staging of liver disease are key barriers in uptake of treatment for chronic hepatitis B and C infection. Our objective was to establish the feasibility of a same day "test and treat" model in two distinct community-based settings in Egypt through use of key point-of-care portable tools for HCV and HBV viral load assessment and staging of liver disease followed by treatment initiation. Community sites were a village in northern Egypt (site 1) and a government office in Cairo (site 2). The following model was adopted: Community awareness-raising in the week before testing; site assessment to ensure optimal placement and calibration of equipment and clinical care; transfer of key portable laboratory instruments to the sites (4 cartridge GeneXpert, Fibroscan and abdominal ultrasound); screening using rapid diagnostic tests for HCV-Ab and HBsAg, with immediate venous or finger-stick blood sampling for HCV-RNA and HBV-DNA measurement, Fibroscan staging of liver disease and ultrasound screening for liver cancer. At site 1, 475 individuals were screened over a single day, 125 were positive for HCV-Ab and 4 for HBsAg, 43 of 56 new HCV diagnoses were HCV-RNA positive, and 3 of 4 HBsAg were HBV DNA positive, 40 initiated on HCV treatment, and one for HBV. At site 2, 3188 individuals were screened over 3 days, 157 were positive for HCV-Ab, and 27 for HBsAg; 38 of 76 new HCV diagnoses were HCV-RNA positive, and 15 of 18 new HBsAg diagnoses HBV DNA positive. Across both sites, 78 patients were counselled and initiated on treatment for HCV and 12 for HBV within 3 hours and 4 hours respectively of initial positive rapid diagnostic tests result. We have shown the feasibility of a same day "test and treat" model for chronic HCV and HBV infection in two community-based settings in Egypt that achieved high levels of linkage to care and initial treatment. Copyright © 2020 John Wiley & Sons Ltd.