A Point-of-Care Model for Hepatitis C Elimination in Remote Islands of Taiwan.

Abstract

Timely and efficient diagnosis of hepatitis C virus (HCV) infection remains the effective approach for the subsequent care cascade of HCV treatment. It is of importance in under-resourced areas. The study aimed to assess the feasibility of a point-of-care (POC) model by a rapid diagnostic test and subsequent confirmational HCV RNA test in remote islands where traffic is an additional hurdle for health care. We conducted a mass POC screening program in 3 outlying islands, including Liuqiu (6.8 km², 12,000 residents), Green (15.1 km², 4280 residents), and Orchid (48.4 km², 5230 residents) islands. We used immunochromatography-based finger-tip assays for HCV antibody detection. Serum HCV RNA was measured among patients seropositive for the rapid anti-HCV test. There were 1055, 268, and 276 adult residents receiving rapid tests in Liuqiu, Green, and Orchid, respectively, yielding response rates of 47.0%, 41.1%, and 24.4%, respectively. The prevalence of anti-HCV-positive were 1.3% (n = 14), 1.1% (n = 3), and 0, respectively. Nine (52.9%) of the 17 anti-HCV-positive patients were HCV RNA-negative. The HCV RNA-positive patients then received anti-viral treatment. The average turnaround time for overall POC HCV test results was 11.8 ± 3.2 min, and the sampling time was completed within 10-30 s. Meanwhile, the labor cost of HCV RNA screening was 156.3 USD, which was a 28.6% decrease compared to traditional methods. The study demonstrated the feasibility and effectiveness of the POC model for HCV elimination in remote islands with limited resources.