Globally, 58 million people are estimated to be living with chronic hepatitis C virus (HCV) infection, with 1.3 million in Myanmar alone. However, the number of diagnosed cases remains low, with only seven percent of people living with HCV diagnosed in Southeast Asia. Contributing to the low rate of diagnosis is the limited number of HCV viral load (VL) platforms available in Myanmar. Therefore, effective strategies are needed to expand access to HCV screening and diagnosis.
Multi-disease testing presents opportunities for expanding testing services by increasing the usage of existing platforms and sharing costs across programs. However, there is limited evidence or guidance on how best to organize device sharing for testing HCV and HIV, particularly in the context of a national program. To date, there is limited operational data on how integrated testing should be organized in centralized laboratories using instruments that can test large numbers of chemical and biological compounds, particularly in Southeast Asia.
In partnership with FIND, the Clinton Health Access Initiative (CHAI) conducted a process evaluation study at Myanmar’s National Health Laboratory to assess the feasibility and acceptability of integrating HCV and HIV diagnostic testing on centralized molecular laboratory platforms, with a comprehensive package of supportive interventions and workflow adjustments.
The study demonstrated that integrating HCV and HIV testing at a large, centralized laboratory with surplus testing capacity was feasible in Myanmar. Adding HCV testing did not adversely impact existing HIV testing and expanded national HCV VL test capacity instead. For successful integration of diagnostic testing, laboratory-specific decisions and investments are needed, such as optimizing workflow, providing adequate human resources, offering additional training for staff, and ensuring ongoing oversight. Integrated testing approaches will be critical to expanding national testing capacity toward HCV elimination in Myanmar and other low-and middle-income countries.