Point of care rapid HCV testing of needle exchange clients: Results from a New Zealand pilot study

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Reynold Melton
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Leadership Day November 23, 2017 Christchurch Geoff Noller, PhD

1 Point of care rapid HCV testing of needle exchange clients: Results from a New Zealand pilot study Matua Raki Addiction Leadership Day November 23, 2017 Christchurch Geoff Noller, PhD Research coordinator National Office, New Zealand Needle Exchange Programme

Rapid testing needle exchange (NEX) clients for HCV 2 Background NZ HCV epidemiology; risk factors / populations People Who Inject Drugs (PWID): numbers,

2 Rapid testing needle exchange (NEX) clients for HCV 2 Background NZ HCV epidemiology; risk factors / populations People Who Inject Drugs (PWID): numbers, accessing NZ Needle Exchange Programme (NEP) Piloting rapid testing the Targeted Testing Project (TTP) Method Rapid tests Sites Results Implications Conclusions

3 Targeted Testing Project (TTP) Rationale 3 Approximately 50,000 New Zealanders chronic HCV NZ data suggest approximately half have been diagnosed Probably less than 10% have accessed treatment (Gane et al., 2014) Estimated >80% of new infections (est per year in NZ) among people who inject drugs (PWID) (e.g. Bennett et al., 2015) PWID hard to reach population, unengaged with primary/secondary care and slow to take up HCV treatment (Wiessing et al., 2014; Iverson et al., 2014)) Historically, relatively low risk of reinfection for previously treated active PWID (Grebely et al., 2017; Weir et al., 2016) New generation of direct acting antivirals (DAAs) Potential to eliminate HCV within 20 years But must increase rates of diagnosis by finding / tracking those infected and reduce pool of infection

The NEP: A national network of needle exchanges (NEXs) (est.

Alternative outlets NZ Prostitutes Collective Sexual health services

4 The NEP: A national network of needle exchanges (NEXs) (est. 1987) 4 NEXs: Peer-based 20 dedicated NEXs (5 trusts) 2 mobile services Alternative outlets NZ Prostitutes Collective Sexual health services Equipment Free needles & syringes $ range of other equipment, e.g. various sized syringe barrels, filters, butterflies, sterile water Approximately 170 pharmacies throughout NZ Level 1 ( 10 packs ) Level 2 (single fits, 10 packs, other equipment Free 1-4-1

5 The Targeted Testing Project TTP 5 Funding from AbbVie to NEP National Office (Oct. 2015) Aim: Engage with NEP clients at identified sites Offer a rapid test Leads to treatment pathway for eligible AB+ve respondents (originally linked to AbbVie Pounamu study) Site selection 1 Auckland, Hamilton, Christchurch (n=350) 2 Auckland, Christchurch, Dunedin (n=350) 3 Christchurch, Dunedin, West Coast (mobile service) (n=200) Identify rapid test the easy part! Actually no SD Bioline DiaQuick HepaScan OraQuick (& SD Bioline) Feb 2016 March 16 April 16 March 2017

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7 Interim Results 7 Table 1: Response rates and demographics for pilot rapid testing at 3 needle exchange sites Site N=x Response Rate % Ethnicity % Sex % Male Caucasian Māori Age Median (Range) % Length of injecting 10 years Christchurch (16-64) 58.6 Dunedin (18-59) 42.0 West Coast (27-60) 84.0 Totals (16-64) 57.6 Table 2: Rapid antibody HCV tests and confirmation at 3 needle exchange sites Site N=x Rapid test AB+ve % % Declined venepunct. % Length of injecting 10 years % Rapid test confirmed venepunct. % No Vp. clinical decision % DNA Christchurch Dunedin West Coast Totals

8 Results Summary Comparison 8 Rapid Testing 6 weeks 203 individuals tested 63.2% AB+ve No anomalous results between the two tests / venepuncture DNA rate 10.9% Genotype (n=50) 1a=48%; 3/3a=48% Questionnaire 75% had been tested ever 42% of those believing they had HCV had not seen a specialist Referral and treatment New diagnoses 14 Treatments started 7 Hepatitis Foundation HCV Pilot ( ) 8 PWID referrals between DNA rate 42% (all referrals) Having the Hepatitis Foundation nurse at the needle exchange for half a day, once a month was not enough... there might only be 5-10 clients during that time. (Primary care) I see that the Foundation are also wanting to embrace rapid testing and I think it would be a really sensible and smart move. I was quite shocked that they didn t embrace it from the beginning. (Primary care)

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10 Acknowledgements 10 The New Zealand Needle Exchange Programme wishes to acknowledge those clients of the service who agreed to participate in this research, and the NEP and clinical staff who worked with these clients. Funding disclosure Funding for this project was received from pharmaceutical company AbbVie Inc. References Bennett, H., McEwan, P., Sugrue, D., Kalsekar, A., & Yuan, Y. (2015). Assessing the long-term impact of treating hepatitis C virus (HCV)-infected people who inject drugs in the UK and the relationship between treatment uptake and efficacy on future infections. PloS one, 10(5), e Gane, E., Stedman, C., Brunton, C., Radke, S., Henderson, C., Estes, C., & Razavi, H. (2014). Impact of improved treatment on disease burden of chronic hepatitis C in New Zealand. NZ Med J, 127(1407), Grebely, J., Dore, G. J., Morin, S., Rockstroh, J. K., & Klein, M. B. (2017). Elimination of HCV as a public health concern among people who inject drugs by 2030 What will it take to get there?. Journal of the International AIDS Society, 20(1). Iversen, J., Grebely, J., Topp, L., Wand, H., Dore, G., & Maher, L. (2014). Uptake of hepatitis C treatment among people who inject drugs attending Needle and Syringe Programs in Australia, Journal of viral hepatitis, 21(3), Hepatitis Foundation of New Zealand. (2014). Process And Outcomes Evaluation Of The Hepatitis C Pilot. September Litmus. Wellington. Weir, A., McLeod, A., Innes, H., Valerio, H., Aspinall, E. J., Goldberg, D. J.,... & Hayes, P. C. (2016). Hepatitis C reinfection following treatment induced viral clearance among people who have injected drugs. Drug and alcohol dependence, 165, Wiessing, L., Ferri, M., Grady, B., Kantzanou, M., Sperle, I., Cullen, K. J.,... & Hope, V. D. (2014). Hepatitis C virus infection epidemiology among people who inject drugs in Europe: a systematic review of data for scaling up treatment and prevention. PloS one, 9(7), e

HCV screening in Australia What we do now, and what we hope to do in future? Professor Gregory Dore

HCV screening in Australia What we do now, and what we hope to do in future? Professor Gregory Dore Disclosures Research grants, travel support, and honoraria: AbbVie, Gilead, Merck HCV screening in Australia