FIND: Self-Administered Tests for Hepatitis C and COVID-19 Could Ease and Broaden the Reach of Testing

Product: HCV self-tests

Product Type: Diagnostics

Disease: Hepatitis C, COVID-19

FIND and DNDi partnered with the Malaysia Ministry of Health on the Hepatitis C Elimination through Access to Diagnostics (HEAD-Start) project to improve the diagnosis of hepatitis C (HCV) by making testing more affordable and more widely available to those in need, with a focus on serving people coinfected with HIV. This project was supported by Unitaid and the Dutch government.

At the outset of this initiative, very few tools available for HCV screening and diagnosis were affordable or appropriate for use at the point of care in low-resource settings. Moreover, these tools were of limited use in certain populations, especially for patients who were coinfected with HIV. Malaysia was using a complicated screening algorithm that was performed in centralized hospitals and took up to six months for results to reach patients.

Through the HEAD-Start study in Malaysia, FIND helped introduce screening using HCV rapid diagnostic tests (RDTs) at primary health centers. This increased access for HCV screening and reduced the time to first result to 15 minutes, enabling the Malaysian Ministry of Health to adopt a decentralized approach to national testing and treatment, bolstering their elimination efforts.

In the era of COVID-19 and lockdowns, HCV self-testing was also seen as  a way to increase access to HCV testing while minimizing the general population’s exposure to the health systems. In addition to benefiting those individuals, this reduces the burden on the health system in a time when systems are particularly strained.

Emerging evidence suggests that men who has sex with men (MSMs) are a high-risk group for HCV, but in the Malaysian context it is very difficult to enable that group to come forward for testing and services. Exploring HCV self-testing among MSMs could expand access to this key population in a way that minimizes the risk of social harm.

Partners in this effort include Orasure, PMC, Wits University, NCDC Georgia, University of Washington, and CRM.

Building on the work in HCV self-testing, FIND, during the COVID-19 pandemic and as co-lead of the Access to COVID-19 Tools (ACT) Accelerator, explored the use of COVID-19 self-tests to make testing more accessible to hard-to-reach communities.

FIND and the Georgian National Center for Disease Control and Public Health (NCDC) implemented a self-testing model to increase access to diagnostics for communities living in remote regions of the country.

In the Svaneti region of Georgia, national mandated weekly testing for school staff meant that people had to travel 2–4 hours (often as close-contract groups in cars) along mountainous roads to access their nearest official COVID-19 testing centre. Before the project launched, communities had no prior knowledge or experience of the self-testing process. This project used schools as a delivery point for self-testing where testing was performed weekly and for symptomatic/contacts for school staff, as well as for household members for symptoms/contacts. Results showed increased confidence in self-management of COVID-19: participants reported that they were not being afraid to visit other people if they tested negative; staff opted for weekly tests regardless of whether they were displaying symptoms even when this was no longer mandated by the government. Upon testing positive, the results were entered in the national database linking them to the standard national algorithm for positive cases, resulting in an SMS from the NCDC with information and a call from their family doctor to assess the case severity and need for treatment.

Based on the study findings, FIND is now supporting Georgia National Centre for Disease Control on scale-up to other healthcare facilities in the Svaneti region and around the country, which has been approved by the Ministry of Health.

These examples showcase the value and the impact that self-testing can have in allowing people to take health in their hands and for communities, especially those that are vulnerable or living in remote regions to access care faster and closer to where they are.