Values and preferences for hepatitis C self-testing among the general population and healthcare workers in Rwanda

HIV, hepatitis, and syphilis self-testing among adolescents and young adults: A systematic review and meta-analysis

BACKGROUND

Adolescents and young adults (AYA) make up a significant share of the world's burden of HIV and other sexually transmitted infections (STI). Self-testing can increase testing coverage and strengthen the uptake of prevention and treatment services. We critically appraised the literature regarding HIV, hepatitis, and syphilis self-testing among AYA (age 10-24 years) and assessed its usability, feasibility, and acceptability.

METHODS

We conducted a systematic review, searching six databases between January 2010 and October 2023. We included all studies on HIV, hepatitis and syphilis self-testing in AYA. We used a random-effects meta-analysis to pool evidence across the three infections as evidence was deemed sufficiently similar. We summarised the uptake, proportion of first-time testers and linkage to care. Qualitative data were narratively synthesised.

FINDINGS

We identified 89 relevant studies. Most were conducted in Africa (57/89, 64 %) and lower-middle-income countries (34/89, 38 %). Our meta-analysis of 27 studies (n = 28,787 individuals) demonstrated that 79 % (95 % CI: 69-87 %, I2 = 99 %) of AYA who were offered HIV or syphilis self-test completed the test. Five studies (n = 4117) demonstrated 62 % (95 % CI: 53-71 %, I2 = 83 %) were first-time testers. No studies reported completion rates for hepatitis self-testing. In general, AYA were highly accepting of self-testing and found it easy to use.

INTERPRETATION

Self-testing is a safe, acceptable and effective way to increase access to HIV, hepatitis and syphilis testing in AYA. Given these features of self-testing, policies to increase its use should significantly improve testing and maximise their public health impact.

Usability and acceptability of self-testing for hepatitis C virus exposure in a high-prevalence urban informal settlement in Karachi, Pakistan

BACKGROUND

Hepatitis C virus (HCV) antibody self-testing (HCVST) may help expand screening access and support HCV elimination efforts. Despite potential benefits, HCVST is not currently implemented in Pakistan. This study aimed to assess the usability and acceptability of HCVST in a high HCV prevalence informal settlement in Karachi, Pakistan.

METHODS

We performed a cross-sectional study in a hepatitis C clinic from April through June 2023. Participants were invited to perform a saliva-based HCVST (OraSure Technologies, USA) while following pictorial instructions. A study member evaluated test performance using a standardized checklist and provided verbal support if a step could not be completed. Perceived usability and acceptability were assessed using a semi-structured questionnaire. The HCVST was considered successful if the participant was able to complete all steps and correctly interpret test results. Overall concordance and positive and negative agreement were estimated in comparison with the HCVST result read by the study member (inter-reader concordance and agreement) and result of a second rapid HCV test (Abbott Diagnostics Korea Inc, South Korea) performed by a trained user (inter-operator concordance and agreement).

RESULTS

The study included 295 participants of which 97 (32%) were illiterate. In total, 280 (95%, 95% CI 92-97%) HCVSTs were successful. Overall, 38 (13%) people performed the HCVST without verbal assistance, 67 (23%) needed verbal assistance in one step, 190 (64%) in two or more. Assistance was most often needed in managing the test buffer and test reading times. The inter-reader concordance was 96% and inter-operator concordance 93%. Inter-reader and inter-operator positive percent agreement were 84 and 70%, respectively. All participants reported they would use HCVST again and would recommend it to friends and family.

CONCLUSION

Saliva-based HCVST was very well accepted in this clinic-based setting. However, many people requested verbal support in several steps, highlighting the need for clear instructions for use and test devices that are simple to use, particularly in low literacy settings. Moderately low positive percent agreement with the results of a rapid test performed by a trained user highlights potential uncertainty in the accuracy of HCVST in the hands of lay users.

Usability and acceptability of oral fluid- and blood-based hepatitis C virus self-testing among the general population and men who have sex with men in Malaysia

Hepatitis C self-testing (HCVST) is emerging as an additional strategy that could help to expand access to HCV testing. We conducted a study to assess the usability and acceptability of two types of HCVST, oral fluid- and blood-based, among the general population and men who have sex with men (MSM) in Malaysia. An observational study was conducted in three primary care centres in Malaysia. Participants who were layman users performed the oral fluid- and blood-based HCVST sequentially. Usability was assessed by calculating the rate of errors observed, the rate of difficulties faced by participants as well as inter-reader (self-test interpreted by self-tester vs interpreted by trained user) and inter-operator concordances (self-test vs test performed by trained user). The acceptability of HCV self-testing was assessed using an interviewer-administered semi-structured questionnaire. Participants were also required to read contrived test results which included "positive", "negative", and "invalid". There was a total of 200 participants (100 general population, 100 MSM; mean age 33.6 ± 14.0 years). We found a high acceptability of oral fluid- and blood-based HCVST across both general population and MSM. User errors, related to timekeeping and reading within stipulated time, were common. However, the majority of the participants were still able to obtain and interpret results correctly, including that of contrived results, although there was substantial difficulty interpreting weak positive results. The high acceptability of HCVST among the participants did not appreciably change after they had experienced both tests, with 97.0% of all participants indicating they would be willing to use HCVST again and 98.5% of them indicating they would recommend it to people they knew. There was no significant difference between the general population and MSM in these aspects. Our study demonstrates that both oral fluid- and blood-based HCVST are highly acceptable among both the general population and MSM. Both populations also showed comparable ability to conduct the tests and interpret the results. Overall, this study suggests that HCVST could be introduced as an addition to existing HCV testing services in Malaysia. Further studies are needed to establish the optimal positioning of self-testing alongside facility-based testing to expand access to HCV diagnosis in the country.

SARS-CoV-2 self-testing in Peru: a cross-sectional survey of values and attitudes of the general population

OBJECTIVES

To assess the values of and attitudes towards the use of rapid SARS-CoV-2 antigen-detection tests for self-testing in a rural and an urban area in Peru.

DESIGN

Cross-sectional, street-based population survey.

SETTING

A series of over 400 randomly selected street points in Valle del Mantaro and in Lima.

PARTICIPANTS

438 respondents (203 female) participated. They were all older than 17 years and provided informed consent for participation.

INTERVENTION

All respondents answered on the spot, a 35-item questionnaire developed in KoboToolbox.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcomes of interest were: likelihood to use a SARS-CoV-2 self-test; willingness to pay for a SARS-CoV-2 self-test and likelihood to comply with recommended actions following a positive SARS-CoV-2 self-test result. Bivariate analyses and Poisson regression (PR) analyses were performed to identify significant associations between dependent variables and independent variables pertaining to respondents' characteristics, risk perception and previous experiences with conventional COVID-19 testing.

RESULTS

Of the 438 respondents, 51.49% had previous experience with conventional COVID-19 testing; 20.37% had COVID-19 disease; 86.96% accepted the idea of SARS-CoV-2 self-testing; and, 78.95% would be likely to use it if needed. Almost all (94.75%) would pay for a self-testing device (mean acceptable payment: US$10.4) if it was not provided free of charge by health authorities. Overall, 93.12%, 86.93% and 85.32% would self-isolate, report the results and warn their contacts, respectively. Being a female (adjusted PR 1.05, 95% CI 1.00 to 1.09, p<0.018), having completed secondary education (adjusted PR 1.18, 95% CI 1.02 to 1.37, p<0.024) and expressing likelihood to use self-testing (adjusted PR 1.08, 95% CI 1.01 to 1.16, p<0.0.24) could be predictors of willingness to pay for a self-test.

CONCLUSIONS

Self-testing is perceived as an acceptable approach. Health authorities in Peru should facilitate access to this approach to complement healthcare facilities-led testing efforts for COVID-19. Future research is necessary to understand the impact of self-testing in case detection and pandemic control.

Usability and acceptability of oral fluid hepatitis C self-testing among people who inject drugs in Coastal Kenya: a cross-sectional pilot study

BACKGROUND

People who inject drugs (PWID) are disproportionally affected by hepatitis C virus (HCV) infection and many remain undiagnosed. HCV self-testing (HCVST) may be an effective approach to increase testing uptake, but has rarely been used among PWID. We assessed the usability and acceptability of HCVST among PWID in Kenya.

METHODS

We conducted a cross-sectional study nested within a cohort study between August and December 2020 on Kenya's North Coast region. Participants were handed a prototype oral fluid HCVST kit and asked to conduct the test relying on the instructions for use. Usability was assessed by documenting errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire.

RESULTS

Among 150 participants, 19% were female and 65.3% had primary level education or lower. 71.3% made at least one error, 56.7% experienced some difficulty during at least one step, and the majority of participants (78%) required assistance during at least one step of the procedure. Most common errors occurred when placing the tube into the stand (18%), collecting the oral fluid sample (24%) and timing of reading results (53%). There was a strong association between presence of symptoms of opiate withdrawals and observed errors (94% vs 62%; p = 0.016) in a sub-group of 74 participants assessed. Inter-reader and inter-operator concordance were 97.7% (kappa: 0.92) and 99.2% (kappa: 0.95), respectively. Acceptability assessed by asking whether participants would choose to use HCVST prior to and after conducting HCVST was 98% and 95%, respectively.

CONCLUSIONS

We found a high acceptability of oral fluid HCVST among PWID. User errors were common and were associated with the presence of withdrawal symptoms among users. Despite errors, most participants were able to obtain and interpret results correctly. These findings suggest that this group of users may benefit from greater messaging and education including options to receive direct assistance when self-testing for HCV.

Protocol for a cluster randomised controlled trial of secondary distribution of hepatitis C self-testing within the context of a house-to-house hepatitis C micro-elimination programme in Karachi, Pakistan

Background

Globally, just 21% of the estimated 58 million people living with hepatitis C virus (HCV) know their status. Thus, there is considerable need to scale-up HCV testing if the World Health Organization (WHO) 2030 hepatitis elimination goals are to be achieved. HCV self-testing may assist with this; however, there are currently no data on the real-world impact of HCV self-testing.

With an estimated 5% of the general population living with HCV, Pakistan has the second highest HCV burden in the world. This study aims to evaluate the acceptability and impact of home delivery of HCV self-testing for secondary distribution in the context of a house-to-house HCV micro-elimination programme in Pakistan.

Methods

This is a parallel group, non-blinded, cluster randomised trial comparing secondary distribution of HCV self-testing with secondary distribution of information pamphlets encouraging individuals to visit a testing facility for HCV screening. The cluster allocation ratio is 1:1. Clusters will be randomised either to HCV self-testing distributed via study staff or control clusters where information on HCV will be given and the participant will be requested to attend their local hospital for HCV screening. In both clusters, only households with a member who has not yet been screened as part of the larger micro-elimination project will be included. The primary outcome is the number and proportion of participants who report completion of testing. Secondary outcomes include the number and proportion of participants who a) receive a positive result and are made aware of their status, b) are referred to and complete HCV RNA confirmatory testing, and c) start treatment. Acceptability, feasibility, attitudes towards HCV testing, and cost will also be evaluated. The target sample size is 2,000 participants.

Discussion

This study will provide the first ever evidence regarding secondary distribution of HCV self-testing. By comparing HCV self-testing with facility-based testing, we will assess whether HCV self-testing increases the uptake of HCV testing. The findings will inform micro-elimination programmes and determine whether HCV self-testing can enable individuals to be reached who may otherwise be missed.

Trial Registration

This study and was registered on clinicaltrials.gov (NCT04971538) 21 July 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13125-9.

Assessing Values and Preferences Toward SARS-CoV-2 Self-testing Among the General Population and Their Representatives, Health Care Personnel, and Decision-Makers: Protocol for a Multicountry Mixed Methods Study

BACKGROUND

Accessible, safe, and client-centered SARS-CoV-2 testing services are an effective way to halt its transmission. Testing enables infected individuals to isolate or quarantine to prevent further transmission. In countries with limited health systems and laboratory capacity, it can be challenging to provide accessible and safe screening for COVID-19. Self-testing provides a convenient, private, and safe testing option; however, it also raises important concerns about lack of counseling and ensuring timely reporting of self-test results to national surveillance systems. Investigating community members' views and perceptions regarding SARS-CoV-2 self-testing is crucial to inform the most effective and safe strategies for implementing said testing.

OBJECTIVE

We aimed to determine whether SARS-CoV-2 self-testing was useful to diagnose and prevent the spread of SARS-CoV-2 for populations in low-resource settings and under which circumstances it would be acceptable.

METHODS

This multisite, mixed methods, observational study will be conducted in 9 countries-Brazil, India, Indonesia, Kenya, Malawi, Nigeria, Peru, the Philippines, and South Africa-and will consists of 2 components: cross-sectional surveys and interviews (semistructured and group) among 4 respondent groupings: the general population, general population representatives, health care workers, and decision-makers. General population and health care worker survey responses will be analyzed separately from each other, using bivariate and multivariate inferential analysis and descriptive statistics. Semistructured interviews and group interviews will be audiorecorded, transcribed, and coded for thematic comparative analysis.

RESULTS

As of November 19, 2021, participant enrollment is ongoing; 4364 participants have been enrolled in the general population survey, and 2233 participants have been enrolled in the health care workers survey. In the qualitative inquiry, 298 participants have been enrolled. We plan to complete data collection by December 31, 2021 and publish results in 2022 via publications, presentations at conferences, and dissemination events specifically targeted at local decision-makers, civil society, and patient groups.

CONCLUSIONS

The views and perceptions of local populations are crucial in the discussion of the safest strategies for implementing SARS-CoV-2 self-testing. We intend to identify sociocultural specificities that may hinder or accelerate the widespread utilization of SARS-CoV-2 self-testing.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/33088.