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.

Need for integration of hepatitis C (HCV) services in community-based settings for people who inject drugs: results from a global values and preferences survey

“…Community-based HCV services, which engage all stakeholders affected by HCV, could be well placed to identify and respond to the specific needs of people who inject drugs and address stigma issues [ 17 , 25 ]. Studies have already shown that community-based HCV (self) testing was highly acceptable [ 26 , 27 ], and one of most preferred ways for testing among people who inject drugs, due to stigma encountered in other healthcare settings [ 28 , 29 ]. Furthermore, studies implementing simplified HCV testing and treatment initiation in community-based settings, and with different levels of community-based engagement throughout the continuum of HCV care [ 30 – 32 ], have provided encouraging evidence to pursue this approach.…”

Acceptability and usability of oral fluid HCV self‐testing for hepatitis C diagnosis: A systematic review and meta‐analysis

“…Finally, screening and full‐text assessment resulted in six included manuscripts comprising 870 individuals from six countries (United States of America [ n = 95 people with chronic liver diseases], Kenya [ n = 150 PWID], Egypt [ n = 116 participants from the general population], Vietnam [ n = 104 MSM and n = 105 PWID], China [ n = 100 MSM] and Georgia [ n = 100 MSM and n = 100 PWID]) (Figure 1). 20–25 All studies were published in English and used OraQuick® HCV Rapid Antibody Test (OraSure Technologies Inc). HCVST results were checked by a healthcare provider in all studies.…”

“…However, it is expected a decrease of HCVST kits price due to the competition on the pipeline of WHO pre‐qualification. A cost‐effectiveness analysis (CEA) using data from those publications from China, 24 Georgia, 25 Vietnam 22 and Kenya 23 was reported in the WHO guideline (Web Annex F—https://www.who.int/publications/i/item/9789240031128). The cost per HCV diagnosis by the standard‐of‐care was extremely variable among those countries (from US$ 35 in Vietnam to US$ 361 in Kenya).…”

“…We did not limit the search to a single oral fluid test manufacturer/product, but all studies used OraQuick® kits pre‐approved for health professional testing that were re‐packed for self‐testing (research‐use‐only) with manufacturer‐provided instructions for use translated into the local language. Three studies 21,23,25 included pictorial instructions using non‐technical language on how to perform HCVST within written instructions for use. Additionally, a trained study staff gave a one‐to‐one, in‐person demonstration on how to use the HCVST kit in the study conducted in Egypt 21 .…”

HIV Sero-Status of Health Care Workers in Addis Ababa Public Hospitals After Post-Exposure Blood and Body Fluids: A Cross-Sectional Study, October 2022

“…Moreover, the epidemiology of HIV in Ethiopia has been on the rise and has been dynamically changing over the past 2 decades, along with poor compliance with standard precautions among HCWs. 13 - 15 …”