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Acceptability and Effectiveness of Point-of-Care HCV Testing in Low- and Middle-Income Countries: A Systematic Review
Win Lei Yee1, Thin Mar Win2, Bridget Draper3,4
1Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Insights
Point-of-care (POC) Hepatitis C virus (HCV) testing in low- and middle-income countries (LMICs) significantly improves testing uptake and linkage to care. Decentralized models show high acceptability and effectiveness for HCV elimination strategies.
Area of Science:
- Public Health
- Infectious Diseases
- Global Health
Background:
- Hepatitis C virus (HCV) diagnosis in low- and middle-income countries (LMICs) traditionally relies on centralized, resource-intensive laboratory services.
- This reliance poses a significant barrier to widespread HCV testing and elimination efforts in these regions.
Purpose of the Study:
- To systematically review and synthesize evidence on the feasibility, effectiveness, and uptake of Point-of-Care (POC) HCV testing in LMICs.
- To inform strategies for scaling up decentralized HCV testing and care models to support global HCV elimination goals.
Main Methods:
- A systematic literature search was conducted across major databases (Medline, Embase, PsycINFO, Cochrane Library) for studies published between 2010 and 2022.
- Two independent reviewers assessed study eligibility and extracted data on testing uptake, linkage to care, and acceptability. Data were descriptively synthesized.
Main Results:
- The review included 20 studies, with 16 examining feasibility and effectiveness, demonstrating high testing uptake and linkage to care.
- Onsite testing and treatment services reported over 90% uptake. HCV self-testing showed high acceptability (91%-99%) among high-risk populations, with oral-based self-tests being more recommended than blood-based tests.
- Decentralized models showed high retention in care and cure rates.
Conclusions:
- Decentralized HCV testing and care models, including POC and self-testing, are effective in improving testing uptake and treatment success in LMICs.
- These approaches are crucial for overcoming barriers associated with centralized diagnostics and advancing HCV elimination efforts globally.
Abstract:
Hepatitis C virus (HCV) diagnosis in low- and middle-income countries (LMICs) relies on costly and technically demanding centralized laboratory services. This review aims to synthesize evidence on Point-of-Care (POC) HCV testing in LMICs to inform scale-up for HCV elimination. We searched Medline, Embase, PsycINFO, and the Cochrane Library for studies on decentralized POC HCV testing in LMICs between 2010 and 2022. Two reviewers independently conducted eligibility assessment and full text review. Testing uptake and linkage data were extracted using Excel, then descriptively synthesized to identify common patterns. Our systematic review identified 2018 reports of which 1603 underwent title and abstract screening. Among them, 58 met the eligibility criteria, but only 20 reports proceeded to data extraction. Of these, 16 examined feasibility and effectiveness, showing high testing uptake and linkage to care. In the 11 reports where services provided onsite testing and/or treatment, uptake of testing and/or treatment exceeded 90%. Four studies assessed HCV self-testing among high-risk populations and showed high acceptability (91%-99%). Studies evaluating oral-based self-testing among high-risk populations reported higher recommendation rates (94%-99%) compared to that of blood-based testing (86.1%). Our findings suggest that decentralized HCV testing and care models likely improve testing uptake and treatment success in LMICs, given the high rates of retention in care and cure.
