Hepatitis C self-testing and self-collection among people with experience in the Canadian carceral system: a qualitative study

The World Health Organization (WHO) has identified hepatitis C virus (HCV) self-testing as a priority to achieve global HCV elimination goals. However, clinical utility and acceptability of HCV self-testing remain limited, especially among individuals with experience of incarceration, a population disproportionally impacted by HCV. This study aimed to explore the perspectives, preferences, and needs of individuals with experience in the Canadian correctional system in the context of HCV self-testing delivery. Individuals with lived experience in the Canadian carceral system were recruited through a national prisoner advocacy organization. Semi-structured interviews were conducted to assess needs and identify preferences for HCV self-testing and self-collection. Data were analysed using an interpretive description methodology to generate clinically relevant insights to inform HCV self-testing rollout programs for people with incarceration experience. Fifteen participants completed interviews between August and October of 2023. Analysis revealed four themes: (1) authentic representation as “words carry power”; (2) altruism triumphs in the face of stigma and uncertainty; (3) distrust of society, systems and even self, further shaped preferences for privacy, autonomy and control and this was paired with; (4) low-barrier and accessible options described as wanting the process to be “easy, easy, easy.” Participants were open to receiving HCV antibody test kits in many ways, with nearly half preferring immediately upon release. Themes informed expectations for promotional materials and that it should be a reflection of the population. Overall distrust of systems led to the desire for flexible options for receiving results, including phone, text, in-person, or email. Participants provided valuable insight into how a self-testing program may be shaped and delivered. This study contributes to the growing evidence base on the implementation of HCV self-testing, ultimately supporting efforts to increase testing rates and linkage to care among those who may benefit from it.