A191 HCV SCREENING VIA RAPID POINT OF CARE TESTING IN PATIENTS ON OPIATE SUBSTITUTION THERAPY IN PEEL REGION, CANADA

Chronic Hepatitis C virus (HCV) infection can lead to cirrhosis, liver failure and liver cancer. HCV is among the most burdensome infectious diseases in Canada, and it is estimated that up to half of infected people are unaware of their infection. Recent data has demonstrated that HCV infected patients who are actively injecting drugs (PWID) or on opiate substitution therapy (OST) have excellent outcomes with new direct-acting antiviral therapy. However, patients on OST remain vulnerable in obtaining access to timely, and unprejudiced diagnostic testing for HCV. The standard-of-care (SOC) in Ontario for diagnosis is for patients to obtain a provincial lab requisition and submit a blood sample for HCV antibodies. Barriers to HCV care include a) invasive nature of procuring sample, b) result turnaround time, c) lack of physician awareness and referral network, and d) lost-to-follow up in this high-risk population. Novel approaches are required for education among healthcare workers for vulnerable populations, and patients themselves. Rapid, non-invasive, point-of-care (POC) HCV testing and diagnosis would better align real-world strategies with these goals. We sought to investigate trends in the SOC vs POC with respect to diagnosis and linkage to care in patients on OST at 3 clinics in Peel Region, Ontario. We hypothesized that patients with a positive HCV antibody obtained via the OraQuick® POC test will have increased linkage to care outcomes regarding their possible infection. We used a commercially available POC HCV rapid antibody test (OraQuick®) that has high specificity and sensitivity in detecting HCV antibodies. Subjects were randomized 1:1 to receive either SOC or POC test. 40 (100%) of oral POC swabs conducted tested negative for HCV. Blood results were received for 7 of 40 (18%) patients in the SOC cohort, all negative for HCV. Of 80 patients enrolled in the study, 32% were female. Canadian-born patients accounted for 67% of subjects, 19% were born in India. 62% of patients were unaware of their HCV status, whereas 38% were aware of a previous negative HCV Ab result. 12/23 patients on OST enrolled from one clinic had no history of injection drug use. The proportion of patients for whom HCV Ab results were available was greater in POC than SOC (100% vs 18%). All patients for whom results have been received have tested negative and therefore no linkage opportunity was triggered. The suspected prevalence of HCV Ab in the Canadian population is approximately 1%; therefore, it was surprising that in a marginalized population with significant risk factors for HCV infection no cases were identified; perhaps due to the small sample size, or lower incidence of injection drug use. The study demonstrated that POC testing uptake worked well as a rapid screening method versus the SOC. Figure 1: Operating Protocol Gilead Sciences Canada

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