Point-of-Care Hepatitis C Testing in a Tribal Setting

Importance: American Indian and Alaska Native people have higher hepatitis C virus (HCV) incidence and mortality rates compared with other racial and ethnic groups. With the point-of-care HCV RNA diagnostic test recently approved for use in the US, the Cherokee Nation integrated diagnostic testing within existing community-based screening efforts to reach underserved community members. Objective: To describe the lessons learned from implementing community-based point-of-care HCV RNA testing, including same-day HCV treatment uptake, in a tribal health setting. Design, Setting, and Participants: This quality improvement study, conducted on the Cherokee Nation reservation in northeastern Oklahoma, collected quantitative data through paper-based surveys and electronic medical records from Cherokee Nation's Infectious Disease Department and harm reduction site, as well as qualitative data from staff meetings. Eligible participants included people aged 22 years or older who visited participating sites from October 30, 2024, to May 28, 2025, and provided informed consent. Exposure: The Cherokee Nation Hepatitis C Engagement and Linkage Program. Main Outcome and Measures: Test acceptance, completion, validity, and results; HCV treatment uptake; and implementation lessons learned. Results: Of the 400 participants (mean [SD] age, 42.5 [12.6] years; 209 [52%] women), 247 of 377 (66%) had a high school degree or less, 309 of 374 (83%) had an annual income of $15 000 or less, and 149 of 385 (39%) reported ever injecting drugs. There were 405 point-of-care HCV RNA tests offered, and 348 (86%) accepted. Of these, 23 (7%) were not performed due to insufficient sample volume. An additional 51 samples (15%) tested were invalid. Of the 274 valid tests, 26 (10%) detected HCV. Of the samples with HCV, 12 (46%) were from American Indian and Alaska Native participants and 14 (54%) were not. Nine participants (35%) with detectable HCV initiated treatment, 6 (67%) the same day, and all who initiated treatment were American Indian and Alaska Native. Most invalid tests occurred within 2 months of implementation. Test validity increased after introducing techniques to improve volume collection. Conclusions and Relevance: In this quality improvement study conducted in a tribal clinic and harm reduction site, point-of-care HCV RNA testing was feasible and effective, with high acceptance and same-day treatment among American Indian and Alaska Native participants. Staff training, addressing logistical barriers, and broadening the population reached supported equitable access to testing. This study supports expanding point-of-care HCV RNA testing and integrated treatment to advance HCV elimination.