Updated recommendations on simplified service delivery and diagnostics for hepatitis C infection

Overview

This policy brief, one of two on the updated hepatitis C (HCV) guidelines, focuses on the new recommendations on simplified service delivery for a public health approach to HCV testing, care and treatment. These recommendations include decentralization, integration and task-sharing, in addition to the use of point-of-care (POC) HCV viral load assays and reflex viral load testing. 

Simplified service delivery (decentralization, integration and task sharing): Expansion of HCV testing and treatment services, ideally at the same site, through decentralization of care to lower-level facilities; integration with existing services, such as in primary care, harm reduction programmes, prisons and HIV services; and promotion of task sharing through delivery of HCV testing, care and treatment by appropriately trained non-specialist doctors and nurses. 

HCV diagnostics – use of POC HCV RNA viral load and reflex HCV RNA viral load testing: The use of POC HCV ribonucleic acid (RNA) assays is now recommended as an alternative approach to laboratory-based RNA assays to diagnose viraemic infection. This is especially applicable to marginalized populations, such as persons who inject drugs, and hard-to-reach communities with limited access to health care and high rates of loss to follow-up. Reflex HCV RNA testing in those with a positive HCV antibody test is recommended as an additional strategy to promote linkage to care and treatment. This can be achieved either through laboratory-based reflex HCV RNA testing following a positive HCV antibody test, using a specimen already held in the laboratory.