Results of the HCV self-testing implementation study through the secondary distribution of HCV self-tests among adult males in Georgia.

BACKGROUND

Scaling up hepatitis C virus (HCV) testing and diagnosis is a critical goal of the Global WHO elimination strategy. HCV self-testing (HCVST) has emerged as a promising self-care approach to improve access and early detection, particularly among hard-to-reach populations. In Georgia, a 2015 HCV serosurvey indicated that 57.3% of anti-HCV reactive individuals were men aged 30–59. This study evaluated a secondary distribution strategy for HCVST aimed at increasing testing uptake among this population in Tbilisi, Georgia.

METHODS

We implemented an observational cross-sectional study evaluating a secondary distribution delivery model of HCVST. We recruited women attending three cancer screening centers. Women who reported having a male family member or partner aged 30–59 years who had not previously been tested for HCV were provided with 1–3 oral fluid HCVST kits to distribute to these men, who were encouraged to complete the test, upload results to an online platform, and complete a questionnaire capturing demographic and risk-related data. Univariate and bivariate analyses were conducted to assess factors associated with reactive HCVST results. Linkage to care was evaluated via the national hepatitis C elimination program database six months after testing.

RESULTS

Between June 2022 and March 2023, 1,859 women were enrolled, distributing 2,744 kits. A total of 852 men uploaded test results; 723 (84.9%) completed the questionnaire. Of these, 16 (1.9%) reported a reactive result, 807 (94.7%) were non-reactive, and 29 (3.3%) indeterminate. Prior HCV testing was reported by 10.3% (n = 88). Reactive results were significantly associated with a history of imprisonment (p < .01) and injection drug use (p = .02). Of the 16 with reactive results, 10 were tested to confirm results at medical facilities, and 9 cases confirmed positive for anti-HCV. Seven (78%) were RNA-positive and initiated treatment.

CONCLUSION

Secondary distribution of HCVST kits through women effectively engaged previously untested men and demonstrated a high rate of follow-up and treatment initiation. This strategy offers a promising model for expanding HCV testing coverage in Georgia. However, strengthened linkage-to-care mechanisms are essential to ensure timely confirmation and treatment of HCV infections identified through self-testing.