Accuracy of rapid and point-of-care screening tests for hepatitis C: a systematic review and meta-analysis.
BACKGROUND
170 million persons worldwide are infected with hepatitis C, many of whom are undiagnosed. Although rapid diagnostic tests (RDTs) and point-of-care tests (POCTs) provide a time- and cost-saving alternative to conventional laboratory tests, their global uptake partly depends on their performance.


OBJECTIVE
To meta-analyze the diagnostic accuracy of POCTs and RDTs to screen for hepatitis C.


METHODS
MEDLINE, EMBASE, BIOSIS, and Web of Science (1992 to 2012) and bibliographies of included articles.


METHODS
All studies evaluating the diagnostic accuracy of POCTs and RDTs for hepatitis C in adults (aged ≥18 years).


METHODS
Two independent reviewers extracted data and critiqued study quality.


RESULTS
Of 19 studies reviewed, 18 were meta-analyzed and stratified by specimen type (whole blood, serum, plasma, or oral fluid) or test type (POCT or RDT). Sensitivity was similarly high in POCTs of whole blood (98.9% [95% CI, 94.5% to 99.8%]) and serum or plasma (98.9% [CI, 96.8% to 99.6%]), followed by RDTs of serum or plasma (98.4% [CI, 88.9% to 99.8%]) and POCTs of oral fluid (97.1% [CI, 94.7% to 98.4%]). Specificity was also high in POCTs of whole blood (99.5% [CI, 97.5% to 99.9%]) and serum or plasma (99.7% [CI, 99.3% to 99.9%]), followed by RDTs of serum or plasma (98.6% [CI, 94.9% to 99.6%]) and POCTs of oral fluid (98.2% [CI, 92.2% to 99.6%]).


CONCLUSIONS
Lack of data prevented sensitivity analyses of specific tests.


CONCLUSIONS
Data suggest that POCTs of blood (serum, plasma, or whole blood) have the highest accuracy, followed by RDTs of serum or plasma and POCTs of oral fluids. Given their accuracy, convenience, and quick turnaround time, RDTs and POCTs may be useful in expanding first-line screening for hepatitis C.


BACKGROUND
Canadian Institutes of Health Research.
McGill University, Montreal, Quebec, Canada.
Sushmita
S
Shivkumar
Rosanna
R
Peeling
Yalda
Y
Jafari
Lawrence
L
Joseph
Nitika
N
Pant Pai
D006526:Hepatitis C / Q000175:diagnosis*; D006801:Humans; D019095:Point-of-Care Systems; D014773:Virology / Q000379:methods*