Patient preferences for simplified hepatitis C testing modalities among people at risk of hepatitis C infection in Australia: the SELECT study

Understanding patient preferences for hepatitis C virus (HCV) testing is essential to improve uptake and support elimination efforts. Despite innovative testing modalities, limited research examines how preferences influence testing choices. This study compared the uptake of HCV testing modalities when participants were given a choice. People at risk of HCV were recruited from community sites in the Australian Hepatitis C Point-of-Care Testing Program. Participants used a visual aid outlining test features, including time to result and collection methods. Those reporting prior HCV infection were offered staff-assisted HCV RNA tests [point-of-care XpertⓇ HCV Viral Load Fingerstick (result in 60 min) or dried blood spot (DBS) (1-2 weeks)]. Participants without prior HCV infection were offered self-administered INSTIⓇ HCV antibody (1 min), staff-assisted INSTIⓇ HCV antibody (1 min), staff-assisted BiolineⓇ HCV antibody (5-20 min), and HCV RNA tests. Participants completed their preferred test, a survey, and received AUD$20 reimbursement. Logistic regression evaluated factors associated with preference for point-of-care RNA testing in those with and without prior HCV infection. 404 people were enrolled (27% female, 75% ever injected drugs). Among those with a history of HCV (n=129), 91% (n=117) selected point-of-care RNA testing and cited the short time to result (52%) and wanting to find out the RNA result today (21%) as key reasons. Among those without a history of HCV (n=275), 72% (n=199) selected staff-assisted INSTIⓇ antibody testing, 19% (n=51) selected point-of-care RNA testing, and 4% (n=10) chose self-administered INSTIⓇ antibody testing. Key reasons for selecting staff-assisted INSTIⓇ included short time to result (75%) and reduced clinic time (8%). Factors associated with selecting point-of-care RNA testing among those without prior infection included recent injecting drug use, homelessness and recent opioid agonist therapy. Findings highlight the importance of offering rapid, staff-assisted HCV testing to improve uptake among at-risk populations.