Local perspectives: Integration of HCV screening and testing in HIV testing sites

Objectives: To describe the challenges, mechanisms, and solutions to integrating rapid and standard HCV testing into the established protocol of the National HIV Behavioral Surveillance (NHBS) system at two sites, Denver and Dallas. Methods: Between August and December 2009, injection drug users (IDU) were recruited using respondent-driven sampling as part of NHBS. In Denver, consenting participants provided a serum sample for standard HCV testing (ORTHOŽ HCV Version 3.0 ELISA), an oral specimen for rapid HIV testing (OraQuick ADVANCEŽ Rapid HIV-1/2 Antibody Test), and a finger stick and second oral specimen to evaluate a rapid HCV test (Chembio DPP HCV Rapid Test). In Dallas, sample specimens and tests were similar for standard HCV and rapid HIV testing. The MedMira Rapid Test using whole blood from a fingerstick was evaluated. Results: The most significant challenge to the integration was drawing blood from overly scarred veins, a common problem with the IDU population. In Denver, we obtained blood draws from 93% of participants, which was only possible because of the expertise of a highly skilled phlebotomist on staff. A second, less significant, challenge was keeping track of the timing to read the multiple rapid tests. In Dallas, we obtained blood samples from 83% of participants. As in Denver, the difficulty of drawing blood from the IDU population required a skilled phlebotomist. Conclusions: An experienced phlebotomist is critical, especially when drawing blood from an IDU population. The HCV rapid tests are easily administered by non-specialized personnel and are a good alternative for use in the IDU population.