New Ways of Testing for Hepatitis C

A conference I attended recently on novel technologies for testing of hep C, HIV, and other blood-borne and sexually transmitted infections, was an eye-opener, looking at new and not-so-new approaches to testing. Some of these methods (or modalities, as they say) are meant to streamline the process of identifying whether people are living with any one of the viral infections, with a view to engaging people into care and treatment as required.

Different ways of testing for hep C

As I mentioned, some are new while others are not so new and have been in use for years in some parts of the world. Sensitivity and the technology vary as well, with some being blood-based and others use a saliva sample. One that stands out in my mind is the dried blood spot method, and I think it has great potential in a number of settings, but not necessarily all. It relies on small blood sample smears on a card that is sent through the mail (or simila), but unlike current rapid testing for hep C, it can include Antibody, RNA, and genotyping all in one test.

For people living in places and circumstances where samples of blood are not easily collected and sent for lab analysis, it can make a big difference, in my opinion. Any way we can make testing simplified is a positive move, albeit not being the whole story.

At-home testing

Another interesting topic is around self-testing, much like what is available now for pregnancy testing that one can purchase at their local pharmacy and easily do at home or in a safe and secure environment where privacy and confidentiality are respected. There are a number of issues to explore and there are a variety of opinions as one might expect. My first question is around "What next?". If a person identifies through a self-testing kit that they are antibody positive, or in time RNA positive, what is the next step? I heard someone suggest that there would have to be a helpline available 24/7 to answer questions and help people with positive results. The most logical next step in for the person to be linked to care and done so in a safe and secure way.

There are potential challenges, recognizing that appropriate care is not readily available everywhere. There would have to be a well-established network of care providers connected and ready to take on the additional testing and treatment needs. This is true in any setting I know, and in our work in testing and linkage to care, we understand it can be done. Scale matters, and costs matter too, no matter where this modality is used.

Looking ahead

Ultimately, we need to find the undiagnosed and engage them in the cascade of care. If we are going to reach the WHO targets for elimination by 2030, we need to look at ways we can do that in a sensible, practical, and effective way. In my opinion, we need to look at unique ways, with no single path as the only one. Keeping our minds open to these novel ideas gives us the potential to reach more people, and that is a good thing, in my view.