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Homeless Healthcare
Published in James Matheson, John Patterson, Laura Neilson, Tackling Causes and Consequences of Health Inequalities, 2020
The National Institute for Clinical Excellence (NICE) guidance recommends that homeless people should be screened for TB, hepatitis C and HIV [32]. Chest x-ray screening is a good tool for the identification of individuals with active TB in this population [33]. Use of dried blood spot testing and outreach work have been shown to improve the uptake of hepatitis C testing [34].
Strategies for the improvement of HCV testing and diagnosis
Published in Expert Review of Anti-infective Therapy, 2019
Facilitating access to screening can be achieved by improving virological tests in terms of rapidity and simplicity. Alternatives models using POC tests and DBS are being increasingly considered for screening. The use of POC tests has been now recommended for HCV screening in recent international guidelines due to the potential to simplify testing algorithms, increase diagnoses and facilitate linkage to treatment in reducing visits. Simplified POC diagnostic testing using oral fluid and capillary blood from fingerstick across a number of different platforms including POC and DBS testing has provided significant advances in hepatitis C infection. Further, these alternatives to classical tests have the potential to reduce non-attendance to off-site phlebotomy and provides more immediate results to facilitate enhanced counseling, education, and linkage to care. Testing by use of RDT in one village in northern Egypt in more than 4,200 eligible villagers has been shown as an important strategy to complement the national government program towards the elimination of HCV [36]. Self-testing in marginalized populations have the potential to reduce the large burden of undiagnosed infection, although linkage to care will still represent a challenge. In high-risk populations, the best HCV screening method is still a matter of debate. A systematic HCV RNA-based screening should be considered in the pursuit of a strategy with the primary goal of implementing an HCV elimination program at the population level [37,38]. Molecular POC tests are now available that facilitate HCV RNA confirmation and diagnosis. That includes the Xpert® HCV Viral Load Fingerstick (Cepheid), and Genedrive® HCV ID Kit (Genedrive Diagnostics). However, the high costs of PCR-based HCV testing limit its implementation in clinical practice. Qualitative NAT technologies are now sufficient to confirm either the presence of the absence of HCV RNA to guide treatment decisions and confirm virological cure. The strategy of using HCV RNA testing to screen high-risk populations with signs of acute HCV infection is however recommended by international guidelines [3]. The introduction of DBS sampling in community drug-services has made an appreciable contribution to screen and to diagnose the HCV-infected population [39,40]. Dried blood spot testing has been shown to enhance HCV testing and linkage to HCV care.