Usability and Acceptability of Self-Testing for Hepatitis C Virus Infection Among the General Population in the Nile Delta Region of Egypt

Abstract

Background Self-testing for hepatitis C virus antibodies (HCVST) may be an additional strategy to expand access to hepatitis C virus (HCV) testing and support elimination efforts. We conducted a study to assess the usability and acceptability of HCVST among the general population in a semi-rural, high-HCV prevalence region in Egypt. Methods An observational study was conducted in two hospitals in the Nile Delta region. A trained provider gave an in-person demonstration on how to use the oral fluid HCVST followed by observation of the participant performing the test. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability of HCV self-testing was assessed using an interviewer-administered semi-structured questionnaire. Results Of 116 participants enrolled, 17 (14.6%) had received no formal education. The majority (72%) of participants completed all testing steps without any assistance and interpreted the test results correctly. Agreement between participant-reported HCVST results and interpretation by a trained user was 86%, with a Cohen’s kappa of 0.6. Agreement between participant-reported HCVST results and provider-administered oral fluid HCV rapid test results was 97.2%, with a Cohen’s kappa of 0.75. The majority of participants rated the HCVST process as easy (53%) or very easy (44%), and 96% indicated they would be willing to use HCVST again and recommend it to their family and friends. Conclusion Our study demonstrates the high usability and acceptability of oral fluid HCVST in a general population. Further studies are needed to establish the optimal positioning of self-testing alongside facility-based testing to expand access to HCV diagnosis in both general and high-risk populations.

Cost-effectiveness of Hepatitis C virus self-testing in four settings

“…In the base case HCVST analysis for each setting, we present the cost-effectiveness of using oral-fluid based self-tests (OraQuick HCV Rapid Antibody Test, OraSure Technologies, PA, USA), as these were evaluated in the HCVST usability study [8]. The sensitivity and specificity of the OraQuick test on an oral sample are reported to be 98% (95% CI 97%-99%) and 100% (95% CI 90%-100%), respectively [25].…”

“…The sensitivity and specificity of the OraQuick test on an oral sample are reported to be 98% (95% CI 97%-99%) and 100% (95% CI 90%-100%), respectively [25]. We adjust the sensitivity and specificity to account for misinterpretation of results during self-testing, as observed by inter-reader agreement in the usability studies in each setting (88-98%, Table 1) [8]. In addition, we make the assumption that 3% of self-tests are used incorrectly so that no result can be reported, but which still lead to the individual linking to facility-based testing (invalid test result).…”

“…The costs of distributing self-tests and standard of care testing and treatment, and the care cascade differ for each setting based on local data ( programmes and HIV self-testing programmes in each setting, expert opinion, and manufacturers (self-test unit costs). We incorporated data on HCVST usage from recent HCVST feasibility and acceptability trials in the study settings [8].…”