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      Point of care and oral fluid hepatitis B testing in remote Indigenous communities of northern Australia.

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          Abstract

          Many Indigenous Australians in northern Australia living with chronic hepatitis B are unaware of their diagnosis due to low screening rates. A venous blood point of care test (POCT) or oral fluid laboratory test could improve testing uptake in this region. The purpose of this study was to assess the field performance of venous blood POCT and laboratory performance of an oral fluid hepatitis B surface antigen (HBsAg) test in Indigenous individuals living in remote northern Australian communities. The study was conducted with four very remote communities in the tropical north of Australia's Northern Territory. Community research workers collected venous blood and oral fluid samples. We performed the venous blood POCT for HBsAg in the field. We assessed the venous blood and oral fluid specimens for the presence of HBsAg using standard laboratory assays. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the POCT and oral fluid test, using serum laboratory detection of HBsAg as the gold standard. From 215 enrolled participants, 155 POCT and 197 oral fluid tests had corresponding serum HBsAg results. The POCT had a sensitivity of 91.7% and specificity of 100%. Based on a population prevalence of 6%, the PPV was 100% and NPV was 99.5%. The oral fluid test had a sensitivity of 56.8%, specificity of 98.1%, PPV of 97.3% and NPV of 65.9%. The venous blood POCT has excellent test characteristics and could be used to identify individuals with chronic HBV infection in high prevalence communities with limited access to health care. Oral fluid performance was suboptimal.

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          Author and article information

          Journal
          J Viral Hepat
          Journal of viral hepatitis
          Wiley
          1365-2893
          1352-0504
          April 2020
          : 27
          : 4
          Affiliations
          [1 ] Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
          [2 ] Department of Infectious Diseases, Royal Darwin Hospital, Casuarina, NT, Australia.
          [3 ] Department of Infectious Diseases, Immunology and Sexual Health, St George & Sutherland Clinical School, UNSW, Kogarah, NSW, Australia.
          [4 ] Miwatj Health Aboriginal Corporation, East Arnhem, NT, Australia.
          [5 ] Top End Health Service, Primary Health Care Branch, Northern Territory Government, Darwin, NT, Australia.
          [6 ] Victorian Infectious Diseases Research Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.
          [7 ] John Hunter Hospital, New Lambton Heights, NSW, Australia.
          [8 ] Victorian Infectious Disease Service, The Royal Melbourne Hospital, Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Vic., Australia.
          Article
          10.1111/jvh.13243
          31785060
          05a04cbe-6a00-4fef-b938-096c5e42878a
          © 2019 John Wiley & Sons Ltd.
          History

          diagnosis,hepatitis B,point of care testing,serologic tests

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