Strategies for the improvement of HCV testing and diagnosis

Introduction: The improvement of number of people diagnosed with hepatitis C virus (HCV) infection is crucial to reach the WHO objectives for eliminating viral hepatitis by 2030. Alternatives to classical HCV virological tests using serum or plasma taken from venous puncture including point-of-care (POC) tests and dried blood spot (DBS) are being considered for HCV screening, diagnosis, and monitoring. Reflex nucleic acid testing and HCV core antigen test have the potential to simplify diagnostic algorithm, increase diagnosis and facilitate linkage to care. Areas covered: This review examines strategies for the improvement of HCV testing and diagnosis including alternatives to classical HCV virological tests and approaches for simplified diagnostic algorithms. Expert opinion: Serological and molecular POC tests are now available for HCV antibody and HCV RNA detections in less than 20 and 60, respectively. DBS offers the main advantage to store desiccated blood that can be easily transported to reference centers where state-of-the-art molecular and serological diagnostic tests are used. Simplifications of diagnostic algorithms are urgently needed to enhance HCV testing, linkage to care and treatment.