Improving Linkage to Care of Hepatitis C: Clinical Validation of GeneXpert® HCV Viral Load Point-of-Care Assay in Indonesia.

Meta Dewi Thedja,Turyadi Turyadi,David Handojo Muljono,Susan Irawati Ie,Korri Elvanita El-Khobar,Dhita Prabasari Wibowo,Lyana Setiawan,Ignatia Sinta Murti

doi:10.4269/ajtmh.20-1588

Abstract

.Hepatitis C virus (HCV) infection large-scale diagnosis and treatment are hampered by lack of a simple, rapid, and reliable point-of-care (POC) test, which poses a challenge for the elimination of hepatitis C as a public health problem. This study aimed to evaluate Cepheid Xpert® HCV Viral Load performance in comparison with the Roche Cobas® TaqMan® HCV Test using serum samples of HCV-infected patients in Indonesia. Viral load quantification was performed on 243 anti-HCV positive patients’ samples using both Xpert HCV VL and Roche HCV tests, followed by HCV genotyping by reverse hybridization. Strength of the relationship between the assays was measured by Pearson correlation coefficient, while level of agreement was analyzed by Deming regression and Bland–Altman plot analysis using log10-transformed viral load values. Quantifiable viral load was detected in 180/243 (74.1%), with Xpert HCV VL sensitivity of 100% (95% CI 0.98, 1.00) and specificity of 98.4% (95% CI 0.91, 0.99) based on the Roche HCV test, while HCV genotypes were determined in 172/180 (95.6%) samples. There was a good correlation between both assays (r = 0.97, P < 0.001), overall and per genotype, with good concordance by Deming regression and a mean difference of −0.25 log10 IU/mL (95% CI −0.33, −0.18) by Bland–Altman plot analysis. Xpert HCV VL test was demonstrated as a POC platform with good performance for HCV diagnosis and treatment decision that would be beneficial for decentralized services in resource-limited areas. HCV testing sites, alongside additional GeneXpert modular systems distributed toward the fight against COVID-19, could ensure some continuity, once this pandemic is controlled.

Highlights

An estimated 170 million people have serological evidence of current or past hepatitis C virus (HCV) infection, and 71 million people have chronic viremic infection.[1]
Quantifiable viral load was detected in 180/243 (74.1%), with Xpert Hepatitis C virus (HCV) VL sensitivity of 100% and specificity of 98.4% based on the Roche HCV test, while HCV genotypes were determined in 172/180 (95.6%) samples
Considering quantifiable viral load as positive and unquantifiable viral load as negative results, the sensitivity of Xpert HCV VL was 100% and the specificity was 98.4% compared with the Roche HCV test

Summary

Introduction

An estimated 170 million people have serological evidence of current or past hepatitis C virus (HCV) infection, and 71 million people have chronic viremic infection.[1] Approximately 399,000 people die each year from hepatitis C, mostly from cirrhosis and hepatocellular carcinoma (HCC).[1,2] This disease imposes a great multifaceted economic burden worldwide that includes direct medical expenses and indirect costs because of impaired quality of life and loss of work productivity.[3] In response to this concern, the World Health Organization (WHO) developed the Global Health Sector Strategy (GHSS) on Viral Hepatitis 2016–2021. The aim is the elimination of viral hepatitis as a major public health threat.[4]

Objectives

Methods

Results

Conclusion