In 2015, a pilot hepatitis C screening program was offered within a hospital-based community dental clinic in Italy. The program was called EASY HCV-test. A point-of-care (POC) hepatitis C screening test was offered before routine dental procedures. More than three-quarters of the dental patients who were approached about the program agreed to be screened. Anyone who screened positive was immediately offered an appointment for confirmatory testing and care. This pilot suggests that a screening program using point-of-care testing at a dental clinic may be an effective strategy to increase screening within a community.
EASY HCV-test program description
Within a hospital-based community dental clinic, patients were asked by their dental hygienist if they would like to be screened for hepatitis C before beginning their routine dental work. If they consented, patients were screened using a saliva-based POC test that provided results within the same visit (see our Prevention in Focus article to find out more). Dental hygienists conducted the test and provided pre- and post-test counselling.
Patients who screened positive were referred to a specialist at the hospital within three working days. This free-of-charge appointment was for confirmatory testing and other diagnostic tests for liver disease. These referrals allowed patients who participated in the EASY HCV-test program to be fast-tracked into treatment once their viral load and genotype were identified.
As part of this program, brochures were distributed in the waiting room to provide patients with information about hepatitis C prevention. Dental hygienists were trained to provide pre-test counselling, to conduct the test and to help patients complete the consent forms. As part of the study, patients were asked to complete an anonymous questionnaire to collect information about their demographic profile, hepatitis C-related risk behaviours and previous testing experiences.
This screening pilot was targeted to patients at a community dental clinic in Milan, Italy. The patients at this clinic were representative of the general public, many of whom would not normally seek out hepatitis C testing.
- Overall, 2377 dental patients were approached to receive testing and 2097 (78.4%) were screened.
- Of those screened, 22 cases returned positive results (approximately 1% of the total sample tested). Twenty-one of these patients were already aware of their hepatitis C status, and one individual had a newly diagnosed hepatitis C infection.
- Of those who completed the anonymous questionnaire, 65% reported never having been tested for hepatitis C.
These results suggest that point-of-care testing in dental clinics can be an effective strategy to increase hepatitis C screening. The dental clinic in the pilot serves a diverse population, many of whom had not previously been tested.
What does this mean for service providers?
In this program, dental hygienists were trained to perform hepatitis C POC testing and provide pre- and post-test counselling. Dental care may be a common and trusted interaction with the health care system for many people. Thus, dental clinics may provide a good environment for hepatitis C screening.
Many public health dental clinics in Canada are targeted to marginalized populations, including low-income families, underhoused populations, seniors and others. Implementing similar programs in Canada may help to reach priority populations who may be more vulnerable to hepatitis C.
In addition, this program shows that training other health professionals or community-based workers to administer these tests could also enhance the capacity to do testing in the community. Partnerships such as this one or with others in the community may be an effective strategy to also increase screening among the general population.
The use of POC tests and rapid referrals to care within this program may have reduced loss to follow-up for patients. Losing patient contact while waiting for test results is often a barrier for hepatitis C diagnosis and treatment. POC testing can return results within the same visit. Additionally, this program partnered with a local hospital to ensure a follow-up appointment for positive screening tests within 24–72 hours.
HIV Screening in Dental Clinics - Case Study
Hepatitis C point of care testing: What is its impact on testing and linkage to care? - Prevention in Focus article
- Parisi MR, Tecco S, Gastaldi G et al. Point-of-care testing for hepatitis C virus infection at alternative and high-risk sites: an Italian pilot study in a dental clinic. New Microbiologica. 2017;40(4):242-45.
- Shaw JL, Farmer JW. An environmental scan of publicly financed dental care in Canada: 2015 update. Canadian Association of Public Health Dentistry; 2015. Available from: http://www.caphd.ca/sites/default/files/FINAL%20-%202015%20Environmental%20Scan%20-%20ENGLISH%20-%2016%20Feb%2016.pdf