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Abstract Details
Diagnostic Accuracy of Point-of-Care HCV Viral Load Assays for HCV Diagnosis: A Systematic Review and Meta-Analysis
Diagnostics (Basel). 2022 May 18;12(5):1255. doi: 10.3390/diagnostics12051255.
1University of North Carolina Project-China, Guangzhou 510095, China.
2Institute for Global Health and Infectious Diseases, University of North Carolina at Chaple Hill, Chapel Hill, NC 27599, USA.
3Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, 1211 Geneva, Switzerland.
4FIND, The Global Alliance for Diagnostics, 1202 Geneva, Switzerland.
5Departments of Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
Abstract
Despite the widespread availability of curative treatment with direct-acting antivirals, a significant proportion of people with HCV remain undiagnosed and untreated. New point-of-care (PoC) HCV RNA assays that can be used in clinical settings may help expand access to testing and treatment. This study aimed to evaluate the diagnostic performance of PoC HCV viral load assays compared to laboratory-based testing. Methods: We searched three databases for studies published before May 2021 that evaluated PoC HCV RNA assays against a laboratory NAT reference standard (Prospero CRD42021269022). Random effects bivariate models were used to summarize the estimates. Stratified analyses were performed based on geographic region, population (PWID, etc.), and specimen type (serum/plasma or fingerstick; fresh or frozen). We used the GRADE approach to assess the certainty of the evidence. Results: A total of 25 studies were eligible. We evaluated five different commercially available viral load assays. The pooled sensitivity and specificity were 99% (95% CI: 98-99%) and 99% (95% CI: 99-100%), respectively. High sensitivity and specificity were observed across different assays, study settings (including LMICs and HICs), and populations. There was a small but statistically significant reduction in sensitivity for fingersticks compared to serum or plasma samples (98% vs. 100%, p < 0.05), but the specificity was similar between frozen and fresh samples. The evidence was rated as moderate-high certainty. Conclusions: PoC HCV viral load assays demonstrate excellent diagnostic performance in various settings and populations. The WHO now recommends using PoC HCV viral load assays as an additional strategy to promote access to confirmatory viral load testing and treatment.