Optimizing Hepatitis C Screening: A Faster, More Efficient Approach
Hepatitis C virus (HCV) remains a significant global health concern, with an estimated 50 million people living with chronic infection worldwide.Despite the availability of highly effective direct-acting antiviral (DAA) treatments, a substantial proportion remain undiagnosed and untreated, contributing to ongoing transmission and liver disease complications. A key challenge lies in improving screening strategies to maximize detection rates while minimizing unnecessary follow-up testing and enhancing patient engagement. Recent research suggests a refined approach to rapid antibody testing could significantly address these issues.
Balancing Speed and Accuracy in HCV Screening
A recent nested study,conducted within the larger QuickStart trial,investigated the impact of shortening the reading time for the widely used OraQuick HCV antibody test. Traditionally, the test is read at 20 minutes. However, researchers explored the feasibility of interpreting results at just 5 minutes. Thier findings, published in the Journal of Viral Hepatology, revealed a compelling trade-off: reducing the read time to 5 minutes decreased false positive results by 13%, but resulted in a 2.5% increase in missed viremic infections.1
This seemingly small difference has substantial implications for public health programs. False positive results trigger confirmatory RNA testing, which is considerably more expensive and time-consuming than the initial antibody screen. Reducing these unnecessary tests can free up resources and accelerate the diagnostic pathway for those who truly need treatment.
The QuickStart Trial: A Context for Innovation
The research was undertaken as part of the QuickStart study in Australia, a nation with a progressive approach to HCV care. Australia provides universal, unrestricted access to DAAs, irrespective of disease severity or patient risk factors. Though, despite this accessibility, the country has observed a concerning decline in both HCV testing and treatment rates. The QuickStart trial aimed to identify innovative strategies to reverse this trend and reinvigorate HCV elimination efforts.2 The trial specifically evaluated different “same-day test-and-treat” models, aiming to streamline the process from diagnosis to cure.
Understanding the Antibody Response: 5 Minutes vs. 20 Minutes
The difference in performance between the 5-minute and 20-minute read times stems from the nature of the antibody response to HCV.The 20-minute reading detects a broader range of antibody levels, including those present from past infections that have resolved – individuals who are no longer actively infected (non-viremic).Conversely, the 5-minute reading primarily identifies higher antibody levels typically associated with current, active viremia.
This distinction suggests a potential “dual approach” to HCV screening. Utilizing the 5-minute read as an initial screen,followed by confirmatory RNA testing only for positive results at that time point,could significantly reduce unnecessary RNA tests.Results positive only at the 20-minute mark could then be interpreted as indicative of resolved infections, avoiding further investigation.
Targeted Screening for high-Risk Populations
Researchers emphasize the importance of “context-sensitive rapid testing,” particularly within marginalized communities disproportionately affected by HCV, such as people who inject drugs. These individuals frequently enough experience barriers to traditional healthcare access and may have complex medical histories. A rapid, accessible testing model, coupled with immediate linkage to care, is crucial for reaching these populations. The convenience and quick turnaround time of point-of-care testing, administered by nurses, can be particularly effective in engaging individuals who might potentially be hesitant to seek conventional medical services.
Further research is needed to refine these screening strategies and to develop approaches that accurately identify individuals with previously resolved infections, ensuring thay are not subjected to unnecessary treatment. By optimizing HCV screening protocols, we can move closer to achieving global elimination of this preventable and curable disease.
References
- Heath K, Guzman R, Elsum I, et al. Balancing efficiency and accuracy in Hepatitis C rapid antibody testing: Insights from a cluster randomised crossover trial. J Viral Hepat. 2025; 32:e70043. doi.org/10.1111/vh.70043.
- K. Heath, J. S. Doyle, I. Elsum, et al., Same- Visit Hepatitis C Testing and Treatment to Accelerate Cure Among People Who Inject Drugs (The quickstart Study): A Cluster randomised cross- over trial protocol. BMJ Open. 2024; 14(7):e083502. doi:10.1136/bmjopen-2023-083502.