Findings from a Project Which Established Hepatitis C Point-of-Care Testing and Linkage to Care at a Homelessness Service in Adelaide, Australia, 2021-2022

Background: Point-of-care hepatitis C virus (HCV) testing streamlines testing and treatment pathways. In this study, we established an HCV model of care in a homelessness service by offering antibody and RNA point-of-care testing. Methods: A nurse and peer-led HCV model of care with peer support were implemented between November 2021 and April 2022 at a homelessness service in Adelaide, Australia. All clients of the service were eligible to participate. Clients were offered an initial antibody point-of-care test, and antibody positive clients were immediately offered RNA point-of-care testing. Clients who tested RNA positive were linked to a viral hepatitis nurse for treatment. Results: A total of 230 clients received an HCV antibody point-of-care test, of which 68 (30%) were antibody positive and 11 (5%) were RNA positive. Of these, seven (64%) clients successfully completed treatment and five (45%) received a sustained virological response (SVR) test to confirm cure. Conclusions: We successfully established HCV testing and a treatment pathway at a homelessness service using HCV antibody and RNA point-of-care testing. The high testing uptake underscores the utility of HCV point-of-care testing when establishing HCV testing and treatment pathways. The low RNA positivity suggests that an initial HCV antibody test was cost-effective, and the four clients diagnosed with chronic HCV who were lost to follow-up indicate a need for enhanced treatment support.