Evaluation of Hepatitis C Virus Core Antigen Assay in a Resource-Limited Setting in Pakistan.

Saeed Hamid,Murad Uddin,Gregory J. Dore,Gavin Cloherty,Safia Awan,Adeel Abid,Tanya Applegate,Taj Muhammad

doi:10.3390/diagnostics11081354

Saeed Hamid, Murad Uddin + Show 6 more

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https://doi.org/10.3390/diagnostics11081354

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Abstract

The diagnosis of Hepatitis C virus (HCV) infection can be challenging due to its cost and a lack of access to centralized testing. There is an urgent need to develop simplified HCV testing algorithms. The aim of this study was to evaluate the performance characteristics of a Hepatitis C core antigen (HCVcAg) assay in a decentralized, resource-limited setting. This is a descriptive cross-sectional study from a highly endemic area of Karachi, Pakistan. Between October 2019 and July 2020, subjects aged 12 years and above who screened positive for HCV antibodies were simultaneously tested for HCV RNA (Xpert HCV Viral Load, GeneXpert® IV, Cepheid, France) and HCVcAg (ARCHITECT HCV Ag assay, Abbott® Diagnostics) to confirm active HCV infection. An Abbott ARCHITECT® i1000SR Immunoassay Analyser was installed at a local district hospital as a point-of-care (POC) facility for HCVcAg testing, while samples for HCV RNA were tested in a central lab. Two hundred individuals (mean age 46.4 ± 14.5 years, 71.5% females), who screened positive for HCV antibody, were included in the study. HCV RNA was detected in 128 (64.0%) while HCVcAg was reactive in 119 (59.5%) cases. Performance of the Immunoassay Analyser was excellent with a higher throughput and quicker readout value compared to the GeneXpert System. The sensitivity and specificity of HCVcAg (≥10 fmol/L) at HCV RNA thresholds of ≥12 was 99.1% (95% CI: 95–100%) and 87.6% (95%CI: 78.4–94%). A strong agreement was observed between the HCVcAg assay and HCV RNA. The ARCHITECT HCV Ag assay showed high sensitivity and specificity compared to HCV RNA in a decentralized, resource-limited setting. It can therefore be used as a confirmatory test in HCV elimination programs, particularly for low-income countries such as Pakistan.

Highlights

Hepatitis C virus (HCV) infection represents a major public health problem, with approximately 80 million individuals living with HCV around the world resulting in an excess of 350,000 deaths per annum [1,2]
The aim of this study was to evaluate the performance characteristics of the Abbott® HCV core antigen (HCVcAg) assay tested in a decentralized location compared to the GeneXpert® HCV Viral Load assay for HCV RNA located in a central lab, using plasma samples from participants of a cohort group living in a resource-limited, HCV endemic area in Pakistan
HCVcAg was reactive in 4 participants negative for HCV-RNA (Table 1)

Summary

Introduction

Hepatitis C virus (HCV) infection represents a major public health problem, with approximately 80 million individuals living with HCV around the world resulting in an excess of 350,000 deaths per annum [1,2]. This is of particular importance to people living in remote and resource-limited settings, where low diagnosis and treatment rates are often attributed to additional barriers at several levels including patient, provider, logistical, structural, and health systems [3,4]. Within the country there are several recognized “hot spots” where the prevalence of HCV infection is much higher than the national average. According to a systematic population based seroprevalence survey of HCV in the resource-limited, peri-urban area of Karachi, the HCV antibody positivity was 23.4% [7]

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