Back to: Linking to Care, Point of Care Testing (POCT). Aotearoa Edition

In our previous lesson we conducted an HCV antibody Pint of Care Test (POCT) and achieved a result. Remembering that the result will have one of three (3) outcomes.

1. Control negative; the test is not valid and inaccurate
   1. The test needs to be conducted again, before retesting rechecks the expiry on the batch or box of test kits, check the packaging for any signs of obvious damage such as water marks. If in doubt use a test kit from another batch, if possible.
   2. Another possibility is that your wai ora, person seeking health, has overcome some of their hesitancy around medical procedures and accessing health care through interactions with you. If a local option for definitive RNA PCR type testing is available it may be worth the conversation for getting your wai ora to get this test.
2. Control positive, Test negative; in theory you wai ora does not have HCV antibodies present.
   1. Ensure your wai ora understands that as of the time of the test being conducted, they have no antibodies evident in the test. The antibodies can take 1 to 12 weeks to show, possibly longer.
   2. Any at risk activities causing exposure in the previous weeks (possibly months) may have not produced antibodies at the time of testing.
   3. Any further at-risk activities may still cause exposure, if any such activities are undertaken or your wai ora suspects any exposure, they should seek a further test.
3. Control positive, Test positive; The test has indicated that HCV antibodies are present in the blood sample taken.
   1. This does not mean that your wai ora has an acute or chronic infection, it simply indicates past exposure to the hepatitis virus that has resulted in the body producing antibodies.
   2. Your wai ora needs to have further testing, an RNA PCR test.
      1. Subject to Health Network Collective arrangements and agreements at local or national level; when you entered the result into the Health Network Collective app an automated request for further testing has been sent to the appropriate organization. This request should be responded to via the applications messaging system, and or email. Both yourself as tester, and your wai ora should receive notification.
      2. In certain settings where mobile RNA PCR testing services are utilized, such notifications may be subject to the mobile units’ schedules and availability.
      3. Organizations you may part of or have collaborative arrangements with; might be in a position to assist with obtaining such testing. Ideally these are conversations you have already had with these organizations prior to the need arising.

Conversation and informing our wai ora, or person seeking health

We are not here as doctors, nurses or clinicians, so keep it simple, clear, concise and to the facts that we know and have learnt here.

Bearing in mind our wai ora might (or might not) fall into any of the following states;

• Nervous; they have been affected by stigma or simply have hesitations in engaging with health-related matters
• Anxiety; Again stigma, anxiety around the impact of possible positive results and having to inform family or friends, and the questions around ‘how and why’ that might arise. And as with many of us, not wishing to be unwell or having a positive diagnosis of any condition.
• Stress; in relation to undergoing a medical procedure or process. Or a combination of all these factors.
• Denial; that an at-risk activity they have been partaking of does have a reality of contributing to ill effects and health compromise.
• Anger; again, possibly a combination of all these factors, and potentially capable of directing this anger towards you. As with fear, sadness, and so many more spectrums of emotional response.
• Some may rapidly progress through the stages of grief; denial, anger, bargaining, depression and acceptance. Many will just show acceptance. Think of the principles of Phycological First Aid (PFA) that we covered in an earlier lesson.

Phycological First Aid (PFA)

• Look, your wai ora appearance can be a great indicator of their mind state and help guide us in our interactions.
• Listen, let them speak if they wish. However, this may be a time that from the point you can identify the test result you maintain a clear concise factual flow of conversation. Your wai ora needs the information so keep it simple and brief, the questions will follow.
• Link, in cases where the wai ora has acknowledged at risk exposure behaviours, suggesting linking them to appropriate support networks or organizations may be of benefit. In some of our addiction populations risks of multiple comorbidities (other conditions) are often present; this may be an opportunity to encourage a visit to medical clinic, facility, community nurse or similar. Dependent on you, you might choose to offer to accompany your wai ora, that is your choice.

It’s important we keep this conversation to the facts, explaining the practical steps needed from this stage to ensure our wai ora have the best opportunity to get the health they seek. Some conversational ideas, though scripted response from you may not be the most favorable as everyone is different and each conversation will have a different conversational bent. The key messaging and themes won’t change that significantly.

Control negative; the test is not valid and inaccurate

1. Thank you so much for coming in for this test today, unfortunately the control indicator has not shown this test as a valid test for the presence or absence of the hepatitis antibodies. This could be for a range of reasons. We will need to conduct a further test and there are a few options;
   1. We can arrange for a PCR test with you (doctor, GP, community nurse, laboratory…). This would be a single blood test that not only shows antibodies, but can also check if active virus is present and if treatment is required. Or…
   2. We can simply conduct another test here, now, with another test kit. (If that the test is positive you will need to have the further PCR test to confirm if virus is present in your blood.)

Control positive, Test negative; in theory you wai ora does not have HCV antibodies present.

1. Thank you so much for coming in for this test today, this test is indicating that you do not have hepatitis C antibodies present in the blood sample we tested. This would suggest that you have not been exposed to the virus. As a matter of course we always like to mention that if you have been exposed in the last few weeks or months the antibodies may not show as yet. If you feel you may have had an exposure risk over that time, please feel free to come back for another test after another 6 weeks, or in any case that you suspect you may have been at further risk of exposure. 
2. Can I give you or send you any information regarding hepatitis C, risk factors, testing or treatment for yourself or family or friends? And please do let us know if you’d like information or links to any support organizations such as mental health, addictions, sexual health and the likes.
3. Do you have any questions?
4. Can I make a follow-up test booking for you in say…6 weeks’ time?

Control positive, Test positive; The test has indicated that HCV antibodies are present in the blood sample taken.

1. Thank you so much for coming in for this test today, this test is indicating that you do have hepatitis C antibodies present in the blood sample we tested. This would suggest that you have been exposed to the hepatitis C virus in the past however this does not tell us if you have actual hepatitis virus currently in your system. Antibodies are formed by your body to fight the HCV virus, so we know the virus has been in you at some stage. We will need to get another test done to see if the active virus is still in your body and how much of it if so. This is called a PCR test which is another blood test that can take longer for the results to come back. That will inform if the 8-12week treatment to possible cure is required
   1. If PCR services are available locally and mobile app is linked
      1. You will receive a notification via your Health Network Collective app and or email letting you know when and where for your PCR test. I will also receive a notification, would you like me to follow up with you prior to this test, or come with you?
   2. If PCR services are available locally and mobile app is not linked
      1. You will need to see your doctor / GP / community nurse / local lab and arrange for a RNA PCR test. Or, ideally… I am happy to arrange for this test for you if that suits, great let me get back to with a time and location (unless that can be arranged on the spot).
   3. If PCR services are available via scheduled mobile service only
      1. We will need to reach out and contact the mobile testing services and see when they are scheduled to be in the area. You’ll either receive a notification via the app or email, or I will let you know.
      2. If you need or want any support for the following test, or any information regarding hepatitis C, risk factors, testing or treatment for yourself or family or friends please do let us know. Same with information or links to any support organizations such as mental health, addictions, sexual health and the likes.
      3. Any questions?
         1. Please consider having printed information available for your wai ora who have tested positive (and negative or invalid). Failing that take a few moments to run over the mobile app and FAQ sections.
         2. In the event of the RNA PCR indicating viral load a prescribing nurse or doctor will need to approve a script for treatment. How this arrangement is made in your region will be made clear via communications and updates via the app and email notification to you.

Post Notifications of initial test result(s)

For many undertaking this course of training in Point of Care Testing for HCV, your ties into the community and supporting organizations very likely lead to your much more personalized involvement with you community. Hence your ability and want to ensure your wai ora, those seeking health, can be assisted by you and your networks in navigating their journey to potential cure and improved health. The Health Network Collective app can assist in this with communications, calendar and appointment scheduling and general information and communications. The app is only a tool though and ultimately your involvement is your choice.

Health Network Collective encourage utilizing local peer and community networks with such support. The links and relationships you have formed with local medical systems and structures is also of vital importance. Community nurses and local NGO’s (Non-Governmental Organizations) are very important links in this ongoing navigation of care. Your wai ora may have direct links and relationships that develop over time, we don’t need to remain in charge or be the director of the journey, more that we are available for support as needed and as indicated.

There will also be relationships that are difficult to maintain, if at all possible. Please remember your personal safety is of most importance, if you ever have doubts step away and seek advice or help.

Please download, read and familiarize yourself with the course material for this lesson. The fact sheets are designed for general information with fact sheets specifically designed for PWID populations and men who have sex with men.