Values, preferences and current hepatitis B and C testing practices in low- and middle-income countries: results of a survey of end users and implementers

Abstract

Background: Access to hepatitis B virus (HBV) and hepatitis C virus (HCV) diagnostics remains a key bottleneck in scale-up of access to HBV and HCV treatment, particularly in low- and middle-income countries (LMICs) that lack laboratory resources and skilled personnel. To inform the development of World Health Organization (WHO) testing guidelines on who to test and how to test, we performed a "values and preferences" survey of end users and implementers of hepatitis testing in LMICs on current hepatitis B and C testing practices and acceptability of diagnostic approaches, as well as preferences for the future.

Methods: The survey consisted of a four-part, 28 question online survey tool using SurveyMonkey software. The invitation to participate was sent via email to a network of contacts in hepatitis clinical care, research, advocacy and industry.

Results: The survey collected responses on current testing practices from 48 respondents in 23 LMICs. Only a small proportion of hepatitis testing is currently funded through government-supported programmes. Most limit their testing programmes to blood donor screening and although testing is recommended in several populations, this is not well implemented. Also, there is still very limited access to virological testing.

Conclusions: The survey showed that HBV and HCV testing programmes in LMICs are inadequate and/or scarce. Lack of affordable diagnostic tests; lack of funding, public education and awareness; absence of national policies and guidelines; and a dearth of skilled health professionals are the most important barriers to scaling up HBV and HCV diagnosis and treatment.

Fig. 1

Target populations for hepatitis B and C testing. a Population that for which HBV (purple) or HCV (pink) testing is currently established in LMIC represented in the survey responses. Values are given in per cent of LMIC from which responses that testing is established were received (n = 23 LMIC). When more than one respondent have provided answers for one country, the responses were merged (see Methods). b Populations for which testing programmes need to be established in priority according to survey respondents. Values are given in per cent of respondents (n = 48 respondents)

Fig. 2

Issues that need to be addressed in order to establish large scale access to HCV diagnostics in LMIC