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

Abstract

AbstractData on the acceptability and usability of hepatitis C virus self‐testing (HCVST) remain scarce. We estimated the pooled rates of acceptability/feasibility and re‐reading/re‐testing agreement of HCVST using oral fluid tests (PROSPERO‐CRD42022349874). We searched online databases for studies that evaluated acceptability, usability and inter‐reader/operator variability for HCVST using oral fluid tests. Pooled estimates of feasibility, agreement and post‐testing perspectives were analysed. Sensitivity analyses were performed in men who have sex with men (MSM) and people who inject drugs (PWID). Heterogeneity was assessed using the I2 statistics. A total of six studies comprising 870 participants were identified: USA (n = 95 with liver disease), Kenya (n = 150 PWID), Egypt (n = 116 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)]. All studies used OraQuick® HCV Rapid Antibody Test. The pooled overall estimates for correct sample collection and for people who performed HCVST without needing assistance in any step (95% confidence interval [CI]) were 87.2% [76.0–95.3] (n = 755; I2 = 93.7%) and 62.6% [37.2–84.8] (n = 755; I2 = 98.0%), respectively. The pooled estimate of agreement for re‐reading was 95.0% [95% CI 91.5–97.6] (n = 831; I2 = 74.0%) and for re‐testing was 94.4% [90.3–97.5] (n = 726; I2 = 77.1%). The pooled estimate of those who would recommend HCVST was 94.4% [84.7–99.6] (n = 625; I2 = 93.7%). Pooled estimates (95% CI) of correct sample collection (72.8% [63.3–81.5] vs. 90.8% [85.9–94.8]) and performance of HCVST without needing assistance (44.1% [14.1–76.7] vs. 78.1% [53.4–95.3]) was lower in PWID compared to MSM. In summary, HCV testing with oral fluid HCVST was feasible and well‐accepted. Oral fluid HCVST should be considered in key populations for uptake HCV testing.