The National Australian HCV Point-of-Care Testing Program - Minimal Dataset

Recruiting

• Conditions: Hepatitis C
• Interventions: Diagnostic Test: Point-of-Care Testing

• Registration Number: NCT05248555
• Lead Sponsor: Kirby Institute

Brief Summary

The National Australian HCV Point-of-Care Testing Program will establish an observational cohort to evaluate whether scale-up of finger-stick point-of-care HCV testing increases diagnosis and treatment for HCV infection. Participants will be recruited from settings providing services to people with a risk factor for the acquisition of HCV infection (including drug treatment clinics, needle and syringe programs, homelessness settings, mental health services, prisons, and mobile outreach). All participants who undergo HCV point-of-care testing at the study site will be included in the data collection. Participants will not receive treatment as a part of this study. Participants who are HCV RNA positive will be linked to standard of care.

Detailed Description

The advent of simple direct-acting antiviral hepatitis C (HCV) therapies with cure rates \>95% is one of the greatest medical advances in decades, having led to a reversal in liver-related mortality. In Australia, treatment uptake has declined between 2016 (32,000 treated) and 2019/20 (2019: 11,500; 2020: 8,500).1 Progress towards HCV elimination has been impeded by COVID-19, affecting the delivery of national and state-based HCV strategies. Improving HCV treatment uptake to reduce disease burden is a key aim of global, national and state-based HCV strategies.2-4

Scale-up of HCV testing and treatment will be required to achieve elimination by 2030. Current diagnostic pathways require multiple visits to a practitioner reducing the proportion who receive a diagnosis. In Australia, 81% of people have had HCV antibody testing (indicates exposure), but only 47% have been HCV RNA tested (indicates active infection and the need for HCV treatment).5 Mathematical modelling suggests that HCV RNA testing needs to increase by at least 50% annually to achieve elimination in Australia by 2030.6

The Kirby Institute is an international leader in research evaluating the Xpert HCV assay (Grebely Lancet Gastro Hep 2017), having built a large network of Xpert platforms for HCV testing in needle and syringe programs, prisons, drug treatment clinics, tertiary hospitals, and Aboriginal Community Controlled Health Service. In Kirby-led research, point-of-care HCV testing interventions in needle and syringe programs and prisons have resulted in high HCV treatment uptake (70-90%). The Kirby Institute and Flinders University also have a strong track record of implementing point-of-care testing for STIs and COVID-19, providing an ideal foundation to scale-up Xpert HCV testing in Australia.

The Kirby Institute and Flinders University will establish the Australian National HCV Point-of-care Testing Program for the scale-up of point-of-care HCV RNA testing in services with high prevalence of HCV infection, including community health centres, drug treatment clinics, needle and syringe programs, and prisons. This program will include the development of standard operating procedures, logistics/deployment, initial set-up, an operator training program, and quality assurance and competency assessment program.

An observational cohort study will be established to evaluate HCV treatment uptake following scale-up of point-of-care HCV testing among people with a risk factor for acquisition of HCV infection or people attending a service caring for people with risk factors for the acquisition of HCV infection.

Participants will be recruited from settings that provide services to people with a risk factor for the acquisition of HCV infection. All participants who undergo point-of-care HCV testing at the study site will be included in the data collection. Participants will not receive treatment as a part of this study. Participants who are HCV RNA positive will be linked to standard of care for any other clinical assessments and treatment initiation.

Study Timeline

• Study Start: 2021-12-01
• Study First Submitted: 2021-12-12
• Study First Submitted QC: 2022-02-09
• Study First Posted: 2022-02-21
• Status Verified: 2024-06
• Last Update Submitted: 2024-06-11
• Last Update Posted: 2024-06-13
• Primary Completion: 2024-12
• Study Completion: 2026-12

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 40000

Inclusion Criteria

• ≥ 18 years of age.
• Received point-of-care HCV testing.

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Exclusion Criteria

• Nil

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Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
People at risk of HCV acquisition	Point-of-Care Testing	Clinic staff will offer HCV point-of-care testing to participants as they access services. Testing will be performed using point-of-care HCV RNA testing.

Primary Outcome Measures

Name	Time	Method
The proportion of HCV infected participants who initiate HCV treatment at 12 weeks	12 Weeks from enrolment	To evaluate the proportion of HCV infected (HCV RNA quantifiable) participants who initiate HCV treatment at 12 weeks following finger-stick point-of-care HCV RNA testing.

Secondary Outcome Measures

Name	Time	Method
To evaluate the proportion of participants who complete HCV (DAA) treatment	52 weeks	To evaluate the proportion of participants who complete HCV direct-acting antiviral (DAA) treatment.
The proportion of participants who accept point-of-care testing	2 years from recruitment commencement	To evaluate the proportion of people who accept point-of-care testing among those offered testing.
To evaluate the time to HCV treatment uptake among HCV RNA positive participants	52 weeks	To evaluate the length of time participants take to initiate HCV treatment after diagnosis
To evaluate proportion of HCV RNA positive participants who initiate HCV treatment	52 weeks	To evaluate the proportion of HCV RNA positive participants who initiate HCV treatment at 12 months (52 weeks) following finger-stick point-of-care HCV RNA testing.
To evaluate the proportion of participants who achieve an SVR	12 weeks	To evaluate the proportion of participants who achieve an SVR (defined as HCV RNA below the lower limit of quantitation at post treatment week 12).
To evaluate the proportion of participants who are HCV RNA negative at 12 months	52 weeks	To evaluate the proportion of participants who are HCV RNA negative at 12 months (52 weeks) following finger-stick point-of-care HCV RNA testing.
The prevalence of HCV infection amongst study participants tested	2 years from recruitment commencement	To evaluate the prevalence of current HCV infection (HCV RNA quantifiable) among people tested.

Trial Locations

Locations (11)

St Vincent's Correctional Health Services; 🇦🇺 Fitzroy, Victoria, Australia

Justice Health and Forensic Mental Health Network; 🇦🇺 Sydney, New South Wales, Australia

Woodford Correctional Centre; 🇦🇺 Woodford, Queensland, Australia

Medically Supervised Injecting Room; 🇦🇺 Melbourne, Victoria, Australia

Lotus Glen Correctional Centre; 🇦🇺 Cairns, Queensland, Australia

Hepatitis Queensland; 🇦🇺 Coorparoo, Queensland, Australia

West Moreton Hospital and Health Service; 🇦🇺 Ipswich, Queensland, Australia

Townsville Correctional Centre; 🇦🇺 Townsville, Queensland, Australia

South Australian Prison Health Service; 🇦🇺 Marden, South Australia, Australia

Mount Gambier Priosn; 🇦🇺 Mount Gambier, South Australia, Australia

Geo Healthcare - The Geo Group Australia Pty Ltd; 🇦🇺 Ravenhall, Victoria, Australia