Background
Current testing technologies
Serological testing
Virological testing
Recommended algorithms for hepatitis testing in 2017 WHO testing guidelines [6]
Author, year and country | Sample type & number | Study population | Diagnostic test (Quantitative) | Reference test (Qualitative) | Sensitivity | Specificity |
---|---|---|---|---|---|---|
Lee et al., 2000, USA [9] | Serum
N = 51 | Patients at risk of HCV infection | Roche AMPLICOR HCV test, version 2.0 | Roche COBAS AMPLICOR TM HCV Test v2.0 | 100% at 50 IU/mL; 91% at 25 IU/mL* | |
Yu et al., 2000, Taiwan [10] | Serum
N = 215 | Patients with chronic HCV | Bayer bDNA-2 Quantiplex HCV test | Roche COBAS AMPLICOR TM HCV Test v2.0 | 95% | – |
Sabato et al., 2007, USA [11] | Plasma
N = 76 | Patients with HCV infection |
Bayer Versant HCV genotype assay | Roche COBAS AMPLICOR TM HCV Test v1.0 | 100% | 100% |
Vermehren et al., 2008, Germany [12] | Serum
N = 65 | Patients with HCV | Bayer Versant HCV genotype assay | Abbott Real-Time Assay | 87% | – |
Technological advances and innovations to improve access to testing
Area of Innovation | Technology or strategy | Primary testing target | Potential future testing target | Potential impact |
---|---|---|---|---|
1. Simplification of algorithms | • Elimination of need for genotyping with access to pan-genotypic DAAs, and only a single time point (SVR12) for assessment of cure | HCV | Reduce costs; Improve uptake | |
2. Sampling approaches | • Dried blood spots (DBS) • Oral fluid | • HCV • HCV | Increase access and coverage, reaching key and target populations | |
3. Innovative testing approaches | • Self-testing • Combo integrated multi-disease tests • Integrated multidisease testing platforms (centralised and decentralised) | • HCV • HCV • HCV | • HBV • HBV | Increase awareness, reduce stigma; Maximise programme synergies and reduce costs. Improve access to testing, |
4. New technologies | • Point-of-care (POC) NAT • HCV core antigen test (as laboratory based assay and in future as POC) | • HCV • HCV | • HBV | Increase access to confirmation of viraemia |
5. Health system improvements | • Integrated testing and service decentralization • Data connectivity • Sample chain and supply management | • HCV | • HBV | Improve timely receipt of results and linkage to care; improve supply chain management; Optimize use of current infrastructure, sample workflow |
Simplification of testing algorithms to improve uptake and reduce costs
Screening for exposure | Confirm viremia | Guide treatment | Treatment baseline/monitoring | Post-treatment | Cost of testing | |
---|---|---|---|---|---|---|
Current Testing scenarios | EIA/RDT | RNA qual | RNA quant Genotyping | Toxicity RNA quant | RNA qual |
~220–1100 USD
|
Future Testing scenarios | EIA/RDT/Oral/DBS | RNA qual/quant | NA | RNA qual/quant | RNA qual/quant |
~15–75 USD
|
New sampling approaches
Dried blood spots for serology and virology to promote testing uptake and linkage to care
Testing using oral fluids
Innovative testing approaches
Self-testing
Combination integrated multi-disease tests
Company | Specimen | Sensitivity (95% CI) | Specificity (95% CI) |
---|---|---|---|
OraSure | HCV Antibody Test | 92.7% (88.8%–96.5%) | 99.8% (99.4%–100%) |
Chembio | HCV Screen | 92.1% (87.7%–96.4%) | 99.2% (98.6%–99.9%) |
HIV-HCV Assay | 91.5% (87.2%–95.7%) | 99.4% (98.8%–99.9%) | |
HIV-HCV-Syphilis | 92.3% (88.4%–96.2%) | 99.3% (98.8%–99.9%) | |
MedMira | HIV/HCV | 79.1% (72.6%–85.5%) | 100% |
HIV/HCV/HBV | 81.5% (75.2%–87.8%) | 100% |
Integrated multidisease testing platforms (centralised and decentralised)
New technologies
Point-of-care (POC) molecular technologies (quantitative and qualitative)
Use of HCVcAg as alternative to NAT
Health system improvements
Integrated testing and decentralisation
Connectivity
Supply chain and sample management
Conclusions and research agenda in viral hepatitis diagnostics
Areas of activity | Key deliverables |
---|---|
Enable platform polyvalence and HCV/HIV integration through supporting DBS protocol development, regulatory approval and policy change | - Evaluation of DBS sampling for centralized EIA and RNA assays - Use of existing HIV lab infrastructure for introducing HCV testing - Demonstrate service delivery advantages of one step sampling (EIA/ RNA) using DBS |
Expand use of HCV core antigen assays | - Compare cAg against gold standard as test of cure using current lab-based technology - Evaluate feasibility, cost, cost-effectiveness and impact of cAg assay as one testing approach in high prevalence populations - Accelerate development of POC cAg devices |
Enable decentralization of HCV services | - Integration of HCV/TB/HIV assays in decentralized settings - Demonstrate feasibility of HCV testing and treatment in different decentralized settings - Costing of different testing/ treatment pathways across countries and sites - Evaluate acceptability and cost-effectiveness of finger stick blood sample collection - Accelerate development of POC molecular devices |
Increase access to quality-assured HCV RDTs | - Piloting quality-assured RDTs using capillary blood in high risk groups - Assess market and feasibility of HCV ST and/or combo test among different populations |