HCV self-testing is a process whereby individuals collect their own specimen (blood or oral fluid), perform the test, and interpret the result themselves. A global systematic review and meta-analysis showed that HIV self-testing increased the uptake of HIV testing in MSM by 1.5% (95% CI: 1.2 to 1.8%) times compared to standard HIV testing. Innovative methods for increasing HCV testing are urgently needed.Įvidence and experiences from a large body of self-testing programmes for HIV and syphilis indicate that HCV self-testing may be an effective approach to address those barriers. A survey on HIV testing found that the number of MSM undergoing facility-based HIV testing reduced by 59.0% (95% CI: 58.0 to 60.0%) after the COVID-19 outbreak. Barriers preventing MSM from accessing HCV testing include lack of knowledge about HCV, low perceived risk of HCV infection, societal marginalization, stigma and discrimination from health care providers, testing cost, limitations of facility-based HCV testing such as inconvenience and lack of privacy, and COVID-19 restrictions. HCV testing services have been centralized and relied on hospital outpatient facilities in China. However, a 2017 nationwide survey revealed that around 60% of Chinese MSM remain untested for HCV. MSM without HIV infection are likely a lower risk group with a prevalence of 1.5% (95% CI: 1.0 to 2.1%). Higher risk for HCV based on factors identified by the WHO. Clusters of HCV infection have been reported among MSM living with HIV and the prevalence of HCV among MSM with HIV is 6.3% (95% CI: 5.3 to 7.5%), and these individuals are at greater risk for HCV infection. MSM in China include individuals at higher risk of HCV among men living with HIV as well as lower risk populations. HCV testing rates are low among both high-risk groups as well as low-risk groups. However, only 34.9% of people know that they have HCV in China. There is a need for testing both high-risk and low-risk individuals, especially in high-burden countries like China. Direct-acting antivirals (DAA) have improved the cure rate of HCV infection to over 95%, providing unique opportunities for achieving viral hepatitis elimination targets established by the World Health Organization (WHO). China has a considerable HCV disease burden accounting for over 7% of the global cases recorded, and the HCV prevalence rates vary geographically, with the northern and western provinces having greater burden. HCV causes approximately 700,000 deaths each year. Registration number: ChiCTR2100048379.Īn estimated 58 million people were living with hepatitis C virus (HCV) worldwide in 2019. Trial registrationĬhinese Clinical Trial Registry. ConclusionsĬompared to the standard of care, providing HCVST significantly increased the proportion of MSM testing for HCV in China, and was cheaper per person tested. The cost per person tested in trial 1 was $654.52 for SOC and $49.83 for HCVST, and in trial 2 was $438.67 for SOC and $53.33 for HCVST. Over half (58.6%, 34/58) of HCV self-testers reported the self-test was their first HCV test. Overall, the proportion of individuals who underwent HCV testing during the trial period was higher in the HCVST arm compared to SOC in trial 1 (estimated risk difference (RD): 71.1%, 95% CI: 54.6 to 87.7%) and trial 2 (estimated RD: 62.9%, 95% CI: 45.7 to 80.1%). ResultsĪ total of 84 men who were HIV-negative (trial 1) and 84 men living with HIV were enrolled (trial 2). Costs were measured using a micro-costing approach. Intervention effects were estimated using multiply imputed data in the main analysis. The primary outcome was the proportion of participants who tested for HCV during the trial period. Men in both trials were randomly assigned (1:1) into standard-of-care (SOC) or HCVST arms. HIV-negative MSM and MSM living with HIV were enrolled from 22 cities in China. Two parallel, unmasked, individual-level randomized controlled trials were conducted. We evaluated the effectiveness and cost of providing HCVST to increase HCV test uptake among MSM in China. HCV self-testing (HCVST) may be an effective strategy to address low rates of HCV test uptake among men who have sex with men (MSM).
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