title: Simultaneous Human Immunodeficiency Virus-Hepatitis B-Hepatitis C Point-of-Care Tests Improve Outcomes in Linkage-to-Care: Results of a Randomized Control Trial in Persons Without Healthcare Coverage.
abstract: Background.  In Europe and the United States, more than two thirds of individuals infected with hepatitis B virus (HBV) or hepatitis C virus (HCV) and 15%-30% of human immunodeficiency virus (HIV)-positive individuals are unaware of their infection status. Simultaneous HIV-, HBV-, and HCV-rapid tests could help improve infection awareness and linkage-to-care in particularly vulnerable populations. Methods.  The OptiScreen III study was a single-center, randomized, control trial conducted at a free clinic ("Médecins du Monde", Paris, France). Participants were randomized 1:1 to receive 1 of 2 interventions testing for HIV, HBV, and HCV: standard serology-based testing (S-arm) or point-of-care rapid testing (RT-arm). The main study endpoints were the proportion of participants who became aware of their HIV, HBV, and HCV status and who were linked to care when testing positive. Results.  A total of 324 individuals, representing mainly African immigrants, were included. In the S-arm, 115 of 162 (71.0%) participants performed a blood draw and 104 of 162 (64.2%) retrieved their test result. In comparison, 159 of 162 (98.2%) of participants randomized to the RT-arm obtained their results (P < .001). Of the 38 (11.7%) participants testing positive (HIV, n = 7; HBV, n = 23; HCV, n = 8), 15 of 18 (83.3%) in the S-arm and 18 of 20 (90.0%) in the RT-arm were linked-to-care (P = .7). In post hoc analysis assuming the same disease prevalence in those without obtaining test results, difference in linkage-to-care was more pronounced (S-arm = 60.0% vs RT-arm = 90.0%; P = .04). Conclusions.  In a highly at-risk population for chronic viral infections, the simultaneous use of HIV, HBV, and HCV point-of-care tests clearly improves the "cascade of screening" and quite possibly linkage-to-care.
authors.affiliation: Sorbonne Universités, Université Pierre-et-Marie-Curie Paris 06, Institut National de la Sante et de la Recherche Medicale (INSERM), Institut Pierre Louis d'Épidémiologie et de Santé Publique ; Service de Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) St. Antoine.
authors.forename: Julie
authors.initials: J
authors.lastname: Bottero
authors.affiliation: Sorbonne Universités, Université Pierre-et-Marie-Curie Paris 06, Institut National de la Sante et de la Recherche Medicale (INSERM), Institut Pierre Louis d'Épidémiologie et de Santé Publique.
authors.forename: Anders
authors.initials: A
authors.lastname: Boyd
authors.affiliation: Laboratoire de Virologie, CHU St. Antoine ; INSERM U1135 Centre d'Immunologie et des Maladies Infectieuses.
authors.forename: Joel
authors.initials: J
authors.lastname: Gozlan
authors.affiliation: Sorbonne Universités, Université Pierre-et-Marie-Curie Paris 06, Institut National de la Sante et de la Recherche Medicale (INSERM), Institut Pierre Louis d'Épidémiologie et de Santé Publique ; Département de Santé Publique , Hôpital St-Antoine, Assistance Publique-Hôpitaux de Paris.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Carrat
authors.affiliation: Médecins du Monde, Centre d'Accueil de Soins et d'Orientation.
authors.forename: Jean
authors.initials: J
authors.lastname: Nau
authors.affiliation: Médecins du Monde, Direction des Missions France , Paris , France.
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Pauti
authors.affiliation: Service de Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) St. Antoine.
authors.forename: Hayette
authors.initials: H
authors.lastname: Rougier
authors.affiliation: Sorbonne Universités, Université Pierre-et-Marie-Curie Paris 06, Institut National de la Sante et de la Recherche Medicale (INSERM), Institut Pierre Louis d'Épidémiologie et de Santé Publique ; Service de Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) St. Antoine.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Girard
authors.affiliation: Sorbonne Universités, Université Pierre-et-Marie-Curie Paris 06, Institut National de la Sante et de la Recherche Medicale (INSERM), Institut Pierre Louis d'Épidémiologie et de Santé Publique ; Service de Maladies Infectieuses, Centre Hospitalier Universitaire (CHU) St. Antoine.
authors.forename: Karine
authors.initials: K
authors.lastname: Lacombe
keywords: HIV; linkage-to-care; point-of-care rapid test; screening; viral hepatitis