Non-risk-based HCV screening at point of care: a prospective pilot

Hepatitis C virus (HCV) transmission continues to be a significant problem among high-risk populations and has prompted widespread risk-factor based screening in Australia. Current evidence indicates a higher-than-expected local HCV prevalence in non-high-risk populations, justifying broader screening strategies in support of national HCV elimination efforts. This pilot study evaluated the feasibility and scalability of a non-risk-based point-of-care HCV screening approach with a focus on consumer experience and acceptability.

Over a 10-month period, individuals attending outpatient and community services were offered point-of-care HCV screening using the Abbott Bioline rapid HCV antibody test. Participants with reactive results received HCV-related education and were referred for confirmatory HCV antibody and RNA testing at local pathology services. Patients with detectable HCV RNA were offered expedited access to the Liver Clinic for assessment and treatment, coordinated by the Liver Clinical Nurse Consultant (CNC).

A total of 1,086 individuals were screened, among whom 1.7% (n = 19) tested positive for HCV antibodies. This is notably higher than the national notification rate of 0.0281% indicating an unrecognised burden of HCV in this population. Among participants, 60.2% reported never having undergone HCV testing before. Consumer satisfaction was highly favourable, with > 95% of patients reporting that the test was easy to complete, and they would recommend it to family and friends. Each patient interaction, including consent, testing, result interpretation, counselling, and documentation, was completed within 20 min. Importantly, the Bioline test did not require laboratory infrastructure or skill set, is easily administered in community or outpatient settings, and delivers immediate results, enabling timely counselling, education, and linkage to care.

This proof-of-concept study demonstrates that non-risk-based opportunistic approach to HCV screening is both acceptable to our community and effective in identifying individuals with previously undiagnosed chronic HCV infection. The approach is scalable, resource-efficient, and represents a viable alternative to traditional, risk-based screening strategies in the context of broader public health efforts toward HCV elimination. Notably, our non-stigmatising "why not?" approach of testing allowed for concomitant education of our consumers and improved awareness of Hepatitis C and other blood-borne viruses.