Values and preferences for hepatitis C self-testing among people who inject drugs in Kyrgyzstan

Alla Bessonova,Guillermo Z. Martínez-Pérez,Emmanuel Fajardo,Danil S. Nikitin,Sergei Bessonov,Sonjelle Shilton

doi:10.1186/s12879-021-06332-z

Alla Bessonova, Guillermo Z. Martínez-Pérez + Show 4 more

Open Access

https://doi.org/10.1186/s12879-021-06332-z

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Abstract

BackgroundThe prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) continues to be a major public-health burden in this highly stigmatised population. To halt transmission of HCV, rapid HCV self-testing kits represent an innovative approach that could enable PWID to know their HCV status and seek treatment. As no HCV test has yet been licenced for self-administration, it is crucial to obtain knowledge around the factors that may deter or foster delivery of HCV self-testing among PWID in resource-constrained countries.MethodsA qualitative study to assess values and preferences relating to HCV self-testing was conducted in mid-2020 among PWID in the Bishkek and Chui regions of Kyrgyzstan. Forty-seven PWID participated in 15 individual interviews, two group interviews (n = 12) and one participatory action-research session (n = 20). Responses were analysed using a thematic analysis approach with 4 predefined themes: awareness of HCV and current HCV testing experiences, and acceptability and service delivery preferences for HCV self-testing. Informants’ insights were analysed using a thematic analysis approach. This research received local ethics approval.ResultsAwareness of HCV is low and currently PWID prefer community-based HCV testing due to stigma encountered in other healthcare settings. HCV self-testing would be accepted and appreciated by PWID. Acceptability may increase if HCV self-testing: was delivered in pharmacies or by harm reduction associations; was free of charge; was oral rather than blood-based; included instructions with images and clear information on the test’s accuracy; and was distributed alongside pre- and post-testing counselling with linkage to confirmatory testing support.ConclusionsHCV self-testing could increase awareness of and more frequent testing for HCV infection among PWID in Kyrgyzstan. It is recommended that peer-driven associations are involved in the delivery of any HCV self-testing. Furthermore, efforts should be maximised to end discrimination against PWID at the healthcare institutions responsible for confirmatory HCV testing and treatment provision.

Highlights

The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) continues to be a major public-health burden in this highly stigmatised population
Diagnosis rates are significantly lower in low- and middle-income countries (LMICs), with just 8% of people living with HCV diagnosed in 2016 [5]
There were 37 informants who were linked to Kyrgyz Network of Harm Reduction (KNHR) services, while 44 participants reported living with HCV

Summary

Introduction

The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) continues to be a major public-health burden in this highly stigmatised population. To halt transmission of HCV, rapid HCV self-testing kits represent an innovative approach that could enable PWID to know their HCV status and seek treatment. The World Health Organization (WHO) testing guidelines for hepatitis B and C recommend routine inclusive testing approaches to ensure access to HCV testing for populations such as people who inject drugs (PWID), because of the stigma, discrimination, criminalisation and difficulties in accessing HCV prevention and care [6, 7]. The use of qualityassured, rapid HCV tests has expanded over recent years in LMICs [9], bridging the diagnostic gap will require additional strategies to reach communities who face challenges in accessing facility-based testing services. HCV self-tests are proposed as a screening approach to increase HCV diagnosis [10]

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