Usability and Acceptability of Oral Fluid Hepatitis C Self-testing Among People Who Inject Drugs in Coastal Kenya: a Cross-sectional Pilot Study

Abstract

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.

HCV Self-Testing to Expand Testing: A Pilot Among Men Who Have Sex With Men in China

“…We found a high level of acceptability of HCV self-testing among Chinese MSM, consistent with reports for HCV self-testing from FIND projects in Vietnam ( 20 ), Egypt ( 21 ), Kenya ( 22 ), and Georgia as well as one other small pilot study in the UK ( 30 ). After the self-testing experience, approximately three-quarters of participants expressed a willingness to use an HCV self-test again or to recommend the self-test to family and friends.…”

“…This study expands the literature by examining the usability, feasibility, and acceptability of HCV self-testing in China. Similar pilot studies on HCV self-testing have been conducted by the FIND and WHO team in different settings and populations in Vietnam ( 20 ), Egypt ( 21 ), Kenya ( 22 ) and Georgia. Findings from this study provide insights for the implementation of HCV self-testing programmes and research among MSM.…”