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Table 3 Key challenges in access to and scale-up of viral hepatitis testing and proposed interventions

From: Survey of programmatic experiences and challenges in delivery of hepatitis B and C testing in low- and middle-income countries

Challenges (number of respondents highlighting issue) Proposed interventions (number of respondents highlighting issue)
1. Community awareness and education
Lack of awareness among community
About disease and its consequences (9)
• About value and availability of testing services (1)
Health beliefs
• Delayed health-seeking behaviour especially in young men (2)
• Self-treatment and traditional medicine (1)
• Fear of stigmatization (1)
1. Community awareness and education
Increase awareness (11)
• Increase implementation of HBV vaccination (2)
2. Service delivery
Laboratory infrastructure
• Poor infrastructure and lack of staff (10)
Lack of access to NAT and FibroScan (8)
• Concern about low quality tests and lack of quality assurance (4)
• Lack of supply management (3)
• Lack of assay for hepatitis delta virus (1)
• Dependence on blood sampling (1)
• Distance to testing services (mainly in urban settings) (1)
• Lack of laboratory network (1)
Poor linkage to hepatitis care
Lack of linkage to care (7)
• Lack of access to harm reduction services (2)
2. Service delivery
• Expand access to assays and technologies: eg. DBS, oral test, point of care test, self-testing, GeneXpert and Fibroscan (12)
• Establish good quality assurance on laboratory tests (6)
• Decentralization of testing sites (3)
• Establishment of referral pathway and expand laboratory networks, to include central/private laboratories and existing HIV testing infrastructure and existing HIV structure (3)
• Offer integrated testing for multiple infections (for HCV, HBV, HIV) (2)
• Expand work with key populations (1)
• Prioritize testing in health care workers (1)
3. Lack of access to treatment
• Unavailability of hepatitis treatments (11)
• Lack of treatment for children (1)
• Slow approval process for new medicines (1)
3. Lack of access to treatment
• Expand treatment availability and access to cheap generic medicine (7)
4. Health care workers (HCW)/laboratory education
Lack of awareness among HCW and service providers
• About disease and its consequences (6)
• About value and availability of testing services (3)
• Lack of physicians who are able to treat hepatitis (especially in children) (2)
Lack of training
For HCW, laboratory technicians and physicians (6)
4. Health care workers (HCW)/laboratory education
• Training/increase technical capacity of care teams in area of hepatitis (10)
• Need more staff (1)
• Establish a degree in hepatitis research (1)
5. National guidance and policies
Lack of national guidance (6)
• Policies not implemented (2)
• No epidemiological data on viral hepatitis (2)
• Policies are discriminating/stigmatizing (1)
5. National guidance and policies
Development of national guidelines/strategy (7)
• Advocacy with policy makers (4)
• Need surveillance data to identify settings and populations with high burden (3)
• Development of policy on PMTCT for viral hepatitis (1)
6. Funding
Lack of sustained funding commitment (9)
• High costs of testing and additional assays to determine treatment eligibility (3)
6. Funding
• Development of funding strategy for testing and treatment (4)
• Costing assessment across cascade of care (1)
  1. HCW health care worker, NAT nucleic acid testing, PMTCT prevent mother to child transmission, DBS dried blood spot. Issues identified by more than five respondants are presented in bold