Print

5.0 Conveying HCV Test Results

Posted in: HCV

The process of conveying an HCV test result (previously post-test counselling) to the person being tested, irrespective of the specific result, is affected by the type of test performed, the setting of the consultation, and testing and the extent, if any, of additional testing required in determining the true HCV status of the person. The person who requests the test is responsible for ensuring that the delivery of the test result is carried out in a setting conducive to discussing the implications of the result and addressing the issues that the result raises (see section 5.2). Where an anti-HCV test has been the only test requested, discussion of the need to progress to viral studies will need to be addressed in the process of informing the person of their actual HCV status. In presenting results to people from countries where English is not the primary language, interpreter services should be accessed.

5.1 Conveying a negative result

This may be a negative anti-HCV result or a negative HCV RNA result. The decision on how a negative HCV test result is provided (e.g. in person, by phone, etc.) should be based on the clinical judgement of the person responsible for conveying the result. This assessment should take into account the psychological capacity of the person being tested to deal with the outcome of testing and his/her understanding of the testing process as evident at the time of the sample collection. It is imperative that the meaning of a negative result is fully understood and that the person being tested receives appropriate information about harm reduction in relation to the spread of BBVs.

Further testing following a negative result (anti-HCV or HCV RNA) is indicated in persons who may be in:

  • a window period prior to seroconversion (negative anti-HCV or HCV RNA in a high-risk situation); and/or
  • the situation of having a known previous infection with persistent anti-HCV positivity but a negative HCV RNA. In this latter situation, a single HCV RNA negative result is highly likely to reflect viral clearance. If liver tests remain abnormal or if re-exposure is possible, two HCV RNA results 6 months apart should be negative before assurance is given that the infection has been cleared.

It is imperative that the clinician makes all attempts to ensure that the result is being provided to the person who was tested.

This includes:

  • confirming the person’s identity;
  • making repeated contact to ensure the person is aware of the availability of the result; and

documenting all efforts to contact the person.

5.2 Conveying a confirmed positive result

This may be a positive HCV Ab or a positive HCV RNA result. Both will have a significant impact for a person and their clinician. Laboratories commonly provide information and the opportunity for consultation to assist the requesting clinician at the time of diagnosis.37 A positive result should always be provided in person by the clinician, except in extenuating circumstances where, for example, it is suspected that the person who has been tested may not return for the result and/or may engage in risk behaviour(s) based on the wrong assumption that they are HCV negative. A positive HCV Ab result will need to be informed by further testing for HCV RNA (or HCV Ag) to clarify whether the person is still infected or has cleared the virus.

The discussion when conveying a positive result should include:30

  • giving the test result in person and in a confidential manner that is sensitive and appropriate to the gender, culture, behaviour, language and literacy level of the person who has been tested;
  • providing information on further testing that may be required to clarify the situation;
  • assessing the need for and providing information about support mechanisms and making provisions for immediate referral to a support agency as required. Providing information on the next steps in staging HCV disease in those who are HCV RNA positive and discussing potential treatment options. It may be necessary to cover these issues over a period of time, in which case a subsequent consultation should be arranged at the time of diagnosis;
  • disclosure strategies to partner, family and friends;
  • legal obligations to disclose HCV status relevant to where the diagnosis is made; and
  • the transmission of HCV and how onward transmission may be prevented.

5.3 Referral for further support

The information and support needs of people who are preparing for diagnostic testing for HCV, or have just received a test result are considerable and diverse. Information provided in a single clinical consultation is often insufficient to meet their needs as understanding develops and different personal factors arise over time. Community- based organisations including hepatitis organisations, Aboriginal Community Controlled Health services, peer-based drug user groups and haemophilia organisations are well placed to assist people who are newly diagnosed to better understand the HCV testing and diagnosis process and provide appropriate support through this critical period. Providing referral to relevant community-based organisations or if available, on-site peer support, to one or more of the following organisations is therefore highly recommended when informed consent for testing is being obtained and as appropriate at other stages of HCV testing and management process.

Hepatitis Australia
National Helpline: 1300 437 222 (1300 HEP ABC)
www.hepatitisaustralia.com

The Australian Injecting and Illicit Drug Users’ League (AIVL)
Telephone: 02 6279 1600
www.aivl.org.au

Haemophilia Foundation Australia (HFA)
Telephone: 03 9885 7800
www.haemophilia.org.au

5.4 People with complex needs

5.4.1 People unconvinced by a negative or positive result

Responding to the needs of this group of people can be time-consuming and there may be complex psychological issues that need to be addressed. Assistance in dealing with these people can be obtained from a range of specialist services which can offer help to refer a person in this predicament to an alternative service for a second opinion.38

5.4.2 People who do not return for positive test results

These people can be unaware of factors that may help them in living with chronic infection and may unknowingly place others at risk. It is important to try and contact these people. This should be done by phone to the person or in written correspondence. The request should be for the person to re-contact the service provider without providing the result per se. Public health units and sexual health clinics can provide advice on person follow-up.

The decision to stop trying to follow-up a person can be a difficult one. Attempts to make contact should be documented in the person’s file. General practice in particular has limited capacity to perform person follow-up and GPs should pass this responsibility on to the local public health unit if they have exhausted their resources. General practitioners should refer to the Royal Australian College of General Practitioners (RACGP) guidelines on follow-up of pathology results.39 All practitioners should be aware of their legal obligations and indemnity cover should they be unable to deliver a positive result.40

5.4.3 Post-mortem testing

HCV tests are not standardised in the post-mortem setting. A pathologist undertaking HCV testing as part of the process of a coronial examination or other post-mortem examination is responsible for ensuring that the other provisions in this policy are adhered to.

Quick links to resources on this page

Information relevant to making a new hepatitis C diagnosis

Hepatitis Australia Hepatitis C Testing Information.2010

Royal Australian College of General Practitioners: Standards for general practices

Good Medical Practice: A Code of Conduct for Doctors in Australia

37. Australasian Society for HIV Medicine (ASHM). Resources. Making a new hepatitis C diagnosis. Available at: http://www.ashm.org.au/default2.asp?active_page_id=393 (Cited 23 March 2012).
38. Australasian Society for HIV Medicine (ASHM). Directory. HIV, viral hepatitis and sexual health services. 2010-2011. Available at: http://www.ashm.org.au/images/Publications/2010-11_Directory.pdf (Cited 23 March 2012).
39. Royal Australian College of General Practitioners. Standards for general practices. 4th edition. October 2010. Available at: http://www.racgp.org.au/Content/NavigationMenu/PracticeSupport/ StandardsforGeneralPractices/Standards4thEdition.pdf (Cited 23 March 2012).
40. Australian Medical Council on behalf of the medical boards of the Australian states and territories. Good Medical Practice: A Code of Conduct for Doctors in Australia. July 2009. Available at: http://www.amc.org.au/images/Final_Code.pdf (Cited 23 March 2012).

Download HCV Testing Policy

Download the full
2017 National HCV Testing Policy v1.2 (PDF, 1.1MB)

See what's changed from previous version -->

 

 ASHM_LOGO_

Development of this site and the 2014 and 2017 revisions of the testing policies was supported by: Australian Government Department of Health and Ageing