Operator perceptions of acceptability of point-of-care hepatitis C RNA testing as a tool for streamlining the care cascade.

BACKGROUND: Point-of-care testing for hepatitis C virus (HCV) infection improves access to testing, facilitates same-day results, reduces loss to follow-up, and streamlines access to treatment. This analysis sought to understand the perspectives of point-of-care HCV RNA testing operators regarding acceptability of point-of-care testing as a healthcare intervention for streamlining the HCV care cascade. METHODS: Semi-structured in-depth interviews were conducted with trained and competent point-of-care HCV RNA testing operators (clinical and nonclinical workers) about delivery of molecular point-of-care HCV testing within the Australian Hepatitis C Point of Care Testing Program. The Theoretical Framework of Acceptability informed this analysis. RESULTS: Overall, 31 point-of-care testing operators were interviewed. Operators perceived point-of-care HCV RNA testing to be highly acceptable as a diagnostic tool. Operator's affective attitude was influenced by the capacity of point-of-care testing to enable timely access to results, with fingerstick testing facilitating initial engagement within the care cascade. Staffing influenced burden on the care cascade, with restricted numbers of trained personnel (limitations of number of trained operators per service at time of data collection) at each service inhibiting testing delivery. Point-of-care HCV RNA testing was regarded as ethical due to its capacity to put treatment decisions in patients' hands. Operationally, the streamlined benefits of point-of-care HCV RNA testing were limited due to different operating and reporting systems, thus affecting intervention coherence. Perceived effectiveness for streamlining the care cascade was influenced by prescriber differences in required pre-treatment clinical assessments. Operators described that point-of-care HCV RNA testing enabled improved clinician self-efficacy of testing and treatment. CONCLUSION: Point-of-care HCV RNA testing was regarded as an acceptable tool for streamlining the HCV care cascade, however, barriers to optimization remain.