Acceptability and Effectiveness of Point-of-Care HCV Testing in Low- and Middle-Income Countries: A Systematic Review.

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.