CONVEYING HCV TEST RESULTS

Conveying hepatitis C test results (previously post-test counselling) is an important part of hepatitis C care. This exchange with people receiving hepatitis C test results is shaped by the type of test performed, the setting of the consultation, the reason for testing and the extent, if any, of additional testing required in determining the current HCV status of the person. The person who requests or performs 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 talking through any concerns that the result raises (see Section 5.2 Conveying a confirmed positive result). Where an HCV antibody test has been the only test requested, it is important to convey to the person being tested that further viral studies are required to determine their current hepatitis C status if the antibody test is positive. However, reflex testing (as discussed in Sections 2.3.3 and 2.4.3), is the preferred mode of testing. In presenting results to people for whom English is not their primary language, interpreter services should be accessed. Care should be taken to provide adequate privacy of consultation in a prison setting.

The outcome may be a negative HCV antibody result or a negative HCV RNA result. A negative result should ideally be provided in person to allow for adequate reassurance of the person, identification of ongoing risk factors for infection and provision of information about appropriate prevention strategies.

Further testing following a negative result (HCV antibody or HCV RNA) is indicated in people who may be in:

a window period before seroconversion (negative HCV antibody or HCV RNA in a high risk situation)
the situation of having a known previous infection with persistent HCV antibody positivity but a negative HCV RNA. In this 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, 2 HCV RNA results 6 months apart should be negative before assurance is given that the infection has been cleared
a high-risk group for re-infection (such as people in prison).

This outcome may be a positive HCV antibody or a positive HCV RNA result. A positive result should ideally be provided in person by the clinician or person responsible for communicating test results (in some instances this may be a peer worker or other non-clinician). Please note: a positive HCV antibody result does not confirm current HCV infection and will need to be confirmed by further testing for HCV RNA to clarify whether the person currently has HCV infection or has cleared the virus. See Section 2.2.

The discussion when conveying a positive result (HCV antibody or HCV RNA) should include:^69,70

giving the test result in a confidential and mutually agreed upon manner that is sensitive and appropriate to the gender, culture, emotional state, language, literacy level and environment (i.e. in the community or prison) of the person who has been tested
education regarding modes of transmission of hepatitis C and prevention strategies to prevent possible onward transmission.

If the person tests HCV antibody positive, the discussion should also include:

information on further testing required to confirm current infection (HCV RNA) or clearance and explanation that the result may not indicate chronic hepatitis C
information on curative treatments available for those who do test HCV RNA positive
information about where to access support and information, including peer support and peer education (see Section 5.3 for peer-based organisations)
information about the treatments available including clarification about eligibility and confirming accessibility for people who may previously have had treatment or those with ongoing risk factors, and education about the efficacy and suitability of currently available treatments assessed against the person’s knowledge about HCV treatment.

If the person tests HCV RNA positive, the discussion should also include:

treatments available for those who have tested HCV RNA positive
their rights and responsibilities
the mode of transmission of HCV and how onward transmission may be prevented
considerations regarding disclosure to partner, family and friends, as well as injecting partners and networks for people who may be sharing injecting equipment (particularly those within prison).^71,72 These considerations should include working with the person to understand prevention strategies and to make decisions they are comfortable making, and, if appropriate, referral to peer organisations (see Section 5.3) who might be able to talk through whatever strategies they might need in relation to whatever they decide regarding disclosure
where a person tests HCV RNA positive and is offered treatment, offer testing (and treatment) to people within their injecting networks if they are comfortable having this discussion with them.

Perceptions regarding testing and treatment are unique to each person and should be discussed. Relevant information may need to be conveyed more than once and possibly by different people including peers. People diagnosed with hepatitis C may have misconceptions about treatment eligibility, cost and side-effects based on the experiences of those treated with the previous interferon-based regimens.⁷³Care should be taken to communicate to people that DAA therapies are available with substantially fewer restrictions than previous hepatitis C therapies. For example, people who inject drugs or are incarcerated are eligible for treatment. There are few out-of-pocket expenses (and no out-of-pocket expenses for those in prison), with access to DAA treatments made available on the PBS and testing costs covered by the MBS, although GP or clinician fees may vary as not all providers bulk bill. DAA treatments are safe and well tolerated for most people, and this fact should be emphasised with anyone considering treatment as some misconceptions remain about treatment side-effects and treatment efficacy.⁷⁴

The potential psychological impact of a diagnosis of hepatitis C has changed considerably since the availability of the DAA therapies, which have led to very high cure rates with shortened treatment duration and high tolerability of treatment. However, not all people are aware of this change while others may face other barriers such as poor vein access or have experienced stigma and discrimination at health services. It is important to proactively manage these potential sources of anxiety, and any other issues that may arise from a positive diagnosis. Where more support is required, a referral can be made to the relevant community-based organisation or, if available, a peer-support service.

Hepatitis Australia

HepLink Australia: 1800 437 222 (1800 HEP ABC)

Note: This number will route the caller to the relevant state or territory hepatitis organisation and can be dialled toll free from within prisons

www.heplink.au

The Australian Injecting and Illicit Drug Users’ League (AIVL)

Telephone: 02 5110 3018

www.aivl.org.au

Email: [email protected]

Note: AIVL is the national organisation representing people who use drugs. AIVL operates Monday to Friday, 9am to 5pm. AIVL member organisations can be found in every state or territory across Australia. AIVL can refer people to organisations or services in their local area, where available.

People who are unaware of their positive result can unknowingly place others at risk and may be unaware of current options for treatment, so it is important to contact people who do not return for results. However, not all people awaiting hepatitis C test results have access to a phone or a fixed address. As such, the manner for conveying test results should be mutually agreed (see Section 5.2) at time of testing.

Attempts to make contact should be documented in the person’s file. Referring clinicians should liaise with their local Public Health Unit for people lost to follow-up. General practitioners should refer to the Royal Australian College of General Practitioners (RACGP) guidelines on follow-up of pathology results.⁷⁵

People in prison may be released or transferred before receiving test results. Adhere to the Justice Health guidelines of the relevant state or territory regarding follow-up for people in prison who are released (or are transferred to another prison within the state or territory) before obtaining their results.