Can Dried Blood Spot Testing Increase Retention in Care for Hepatitis C?

Non-retention in care for hepatitis C is a challenge, even when participation rates are high among innovative testing and care centers such as the use of dried blood spot testing (DBS), according to a paper published in International Journal of Drug Policy.

Investigators from Spain conducted a retrospective study in 2 phases in order to determine the barriers to diagnosis and treatment among people with hepatitis C virus. The study authors wrote that people who attend drug treatment centers have a high burden of hepatitis C, and this population faces barriers to both diagnosis and treatment. One proposed way to simplify diagnosis is DBS testing, but regardless, patients remain untreated.

Authors of a 2020 study that evaluated DBS testing for hepatitis B, C, and HIV diagnosis described the test as a blood sampling test that can be performed outside of care facilities. The test involves a capillary puncture that is transferred and dried on a paper card which is then transported by mail in a simple and safe way. The World Health Organization recommends this method, they said, as it can be instrumental in reaching hard-to-reach populations and those living in low-income settings.

For the first phase, the study authors analyzed retention in care, adherence to treatment, and predictive factors in the DBS testing program. These findings among patients treated at the drug treatment centers were compared to a group of patients treated at the hospital outpatient clinic.

Of the 512 patients attending drug treatment centers, 467 agreed to be tested for hepatitis C, the study authors reported. From that group, 237 patients tested positive, the investigators added, noting that the mean age was 46 years and the group was majority male (87%).

Once the study authors determined which patients tested negative for RNA or were under surveillance, a total of 178 were scheduled to meet with a specialist. Of that group, 44 patients did not attend. Furthermore, 25 patients did not complete the pre-treatment evaluation and the only factor that was associated with retention in care was the patient’s knowledge of hepatitis C infection.

Patients attending the drug treatment centers had lower rates of treatment adherence compared to the hospital outpatient clinic group (68 patients vs. 135 patients, respectively).

The next phase of the study was centered on evaluating patients who were lost to follow-up from drug treatment centers and trying to determine the efficacy of one-step testing and telemedicine plus a decentralized dispensation of hepatitis C medication compared to standard of care.

There were 69 patients who attended the drug treatment centers but were lost to follow-up. The proportion of the patients who completed the program (about two-thirds) was significantly higher among those assisted by telemedicine than by standard of care (about 25%).

“Although there was a high participation rate in a DBS testing program in drug treatment centers, non-retention in care is a challenge,” the study authors concluded. “Importantly, telemedicine linked to a decentralized dispensation of hepatitis C treatment re-engages patients and may be effective for hepatitis C micro-elimination.”