Service provider perceptions of incorporating hepatitis C testing technologies into standard practice: Considerations for widespread implementation and scale-up.

BACKGROUND: Simplification of hepatitis C virus (HCV) testing technologies has facilitated scale-up of testing and treatment of at-risk populations in various service settings. Service provider perspectives on the incorporation of simplified diagnostics into standard of care would inform optimised implementation of these technologies. The aim of this study was to qualitatively explore provider perceptions of simplified HCV testing modalities and how they envisage their implementation into standard practice in Australia.

METHODS: Between October 2022 and July 2023, semi-structured interviews occurred with providers from community-based services providing care to people at-risk of HCV infection. Participants were recruited with purposeful/purposive sampling from six states/territories in Australia. Interviews were conducted via Zoom or phone call wherein participants were asked about their HCV dried blood spot (DBS) and point-of-care testing experiences and challenges to implementation. Multiple codes were informed by the Consolidated Framework for Implementation Research (CFIR) and data codes (Partnerships, Policies, Financing, Compatibility, and Adaptability) were analysed with iterative categorisation.

RESULTS: Thirty-six providers were interviewed, of which 21 were in nursing roles, six were non-clinical (e.g., project coordinator), five were peer workers, and four were physicians. Thirty participants had point-of-care experience, and 23 had DBS experience. Overall, participants held positive views of new testing modalities but identified clear barriers to realisation of HCV elimination targets. Partnerships were identified as key enablers with linkage to HCV prescribers a noted gap. Interpretation and application of clinic or national/state policies seemed to impact timeliness of treatment or hinder care. Both testing modalities were mostly regarded as cost-effective, but long-term financing was needed for sustainability, particularly given shifts in staff workloads. Optimal implementation of testing modalities depended on compatible qualities of the testing environment, including HCV prevalence, rurality, available resources and staff, and client visit frequency (e.g., methadone clinic versus emergency department).

CONCLUSION: The expansion of HCV testing and care necessitates that more structural support (e.g., adequate funding and staffing) be offered to service providers. Despite the adaptability of providers, a one-size-fits-all approach will not suit the needs of all settings.