Usability and acceptability of oral-based HCV self-testing among key populations: a mixed-methods evaluation in Tbilisi, Georgia

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Abstract

Background

Hepatitis C virus self-testing (HCVST) is an additional approach that may expand access to HCV testing. We conducted a mixed-methods cross-sectional observational study to assess the usability and acceptability of HCVST among people who inject drugs (PWID), men who have sex with men (MSM) and transgender (TG) people in Tbilisi, Georgia.

Methods

The study was conducted from December 2019 to June 2020 among PWID at one harm reduction site and among MSM/TG at one community-based organization. We used a convergent parallel mixed-methods design. Usability was assessed by observing errors made and difficulties faced by participants. Acceptability was assessed using an interviewer-administered semi-structured questionnaire. A subset of participants participated in cognitive and in-depth interviews.

Results

A total of 90 PWID, 84 MSM and 6 TG were observed performing HCVST. PWID were older (median age 35 vs 24) and had a lower level of education compared to MSM/TG (27% vs 59%). The proportion of participants who completed all steps successfully without assistance was 60% among PWID and 80% among MSM/TG. The most common error was in sample collection and this was observed more often among PWID than MSM/TG (21% vs 6%; p = 0.002). More PWID requested assistance during HCVST compared to MSM/TG (22% vs 8%; p = 0.011). Acceptability was high in both groups (98% vs 96%; p = 0.407). Inter-reader agreement was 97% among PWID and 99% among MSM/TG. Qualitative data from cognitive (n = 20) and in-depth interviews (n = 20) was consistent with the quantitative data confirming a high usability and acceptability.

Conclusions

HCVST was highly acceptable among key populations in Georgia of relatively high educational level, and most participants performed HCVST correctly. A significant difference in usability was observed among PWID compared to MSM/TG, indicating that PWID may benefit from improved messaging and education as well as options to receive direct assistance when self-testing for HCV.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07484-2.

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Most cited references 35

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Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

Mandeep Sekhon, Martin Cartwright, Jill Francis (2017)

Background It is increasingly acknowledged that ‘acceptability’ should be considered when designing, evaluating and implementing healthcare interventions. However, the published literature offers little guidance on how to define or assess acceptability. The purpose of this study was to develop a multi-construct theoretical framework of acceptability of healthcare interventions that can be applied to assess prospective (i.e. anticipated) and retrospective (i.e. experienced) acceptability from the perspective of intervention delivers and recipients. Methods Two methods were used to select the component constructs of acceptability. 1) An overview of reviews was conducted to identify systematic reviews that claim to define, theorise or measure acceptability of healthcare interventions. 2) Principles of inductive and deductive reasoning were applied to theorise the concept of acceptability and develop a theoretical framework. Steps included (1) defining acceptability; (2) describing its properties and scope and (3) identifying component constructs and empirical indicators. Results From the 43 reviews included in the overview, none explicitly theorised or defined acceptability. Measures used to assess acceptability focused on behaviour (e.g. dropout rates) (23 reviews), affect (i.e. feelings) (5 reviews), cognition (i.e. perceptions) (7 reviews) or a combination of these (8 reviews). From the methods described above we propose a definition: Acceptability is a multi-faceted construct that reflects the extent to which people delivering or receiving a healthcare intervention consider it to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention. The theoretical framework of acceptability (TFA) consists of seven component constructs: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Conclusion Despite frequent claims that healthcare interventions have assessed acceptability, it is evident that acceptability research could be more robust. The proposed definition of acceptability and the TFA can inform assessment tools and evaluations of the acceptability of new or existing interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2031-8) contains supplementary material, which is available to authorized users.

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How to Construct a Mixed Methods Research Design

Judith Schoonenboom, R. Johnson (2017)

This article provides researchers with knowledge of how to design a high quality mixed methods research study. To design a mixed study, researchers must understand and carefully consider each of the dimensions of mixed methods design, and always keep an eye on the issue of validity. We explain the seven major design dimensions: purpose, theoretical drive, timing (simultaneity and dependency), point of integration, typological versus interactive design approaches, planned versus emergent design, and design complexity. There also are multiple secondary dimensions that need to be considered during the design process. We explain ten secondary dimensions of design to be considered for each research study. We also provide two case studies showing how the mixed designs were constructed.

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Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Graham Cooke, Isabelle Andrieux-Meyer, Tanya L. Applegate … (2019)

Viral hepatitis is a major public health threat and a leading cause of death worldwide. Annual mortality from viral hepatitis is similar to that of other major infectious diseases such as HIV and tuberculosis. Highly effective prevention measures and treatments have made the global elimination of viral hepatitis a realistic goal, endorsed by all WHO member states. Ambitious targets call for a global reduction in hepatitis-related mortality of 65% and a 90% reduction in new infections by 2030. This Commission draws together a wide range of expertise to appraise the current global situation and to identify priorities globally, regionally, and nationally needed to accelerate progress. We identify 20 heavily burdened countries that account for over 75% of the global burden of viral hepatitis. Key recommendations include a greater focus on national progress towards elimination with support given, if necessary, through innovative financing measures to ensure elimination programmes are fully funded by 2020. In addition to further measures to improve access to vaccination and treatment, greater attention needs to be paid to access to affordable, high-quality diagnostics if testing is to reach the levels needed to achieve elimination goals. Simplified, decentralised models of care removing requirements for specialised prescribing will be required to reach those in need, together with sustained efforts to tackle stigma and discrimination. We identify key examples of the progress that has already been made in many countries throughout the world, demonstrating that sustained and coordinated efforts can be successful in achieving the WHO elimination goals.

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Author and article information

Contributors

Elena Ivanova Reipold: Elena.Ivanova@finddx.org

Journal

Journal ID (nlm-ta): BMC Infect Dis

Journal ID (iso-abbrev): BMC Infect Dis

Title: BMC Infectious Diseases

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2334

Publication date (Electronic): 31 May 2022

Publication date PMC-release: 31 May 2022

Publication date Collection: 2022

Volume: 22

Electronic Location Identifier: 510

Affiliations

[1 ]GRID grid.452485.a, ISNI 0000 0001 1507 3147, The Foundation for Innovative New Diagnostics (FIND), ; Campus Biotech, Chemin des Mines 9, 1202 Geneva, Switzerland

[2 ]GRID grid.48004.38, ISNI 0000 0004 1936 9764, Liverpool School of Tropical Medicine (LSTM), ; Liverpool, UK

[3 ]GRID grid.419393.5, ISNI 0000 0004 8340 2442, Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW), ; Blantyre, Malawi

[4 ]GRID grid.10595.38, ISNI 0000 0001 2113 2211, College of Medicine, , University of Malawi (CoM), ; Blantyre, Malawi

[5 ]Non-Governmental Organization New Way, Tbilisi, Georgia

[6 ]Community-Based Organization Equality Movement, Tbilisi, Georgia

[7 ]National Centre for Disease Control and Public Health of Georgia, Tbilisi, Georgia

[8 ]GRID grid.3575.4, ISNI 0000000121633745, Department of Global HIV, Hepatitis and STI Programmes, , World Health Organization, ; Geneva, Switzerland

Article

Publisher ID: 7484

DOI: 10.1186/s12879-022-07484-2

PMC ID: 9154030

PubMed ID: 35641908

SO-VID: d5481cc1-0771-494d-9989-88d6df964d56

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 31 July 2021

Date accepted : 18 May 2022

Custom metadata

ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hcv,screening,oral fluid,self-testing,acceptability,msm,pwid,georgia

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: hcv, screening, oral fluid, self-testing, acceptability, msm, pwid, georgia

Usability and acceptability of oral-based HCV self-testing among key populations: a mixed-methods evaluation in Tbilisi, Georgia

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HIV Self-Testing

Most cited references 35

Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework

How to Construct a Mixed Methods Research Design

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

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