Reach and uptake of facility- and home-based hepatitis C self-testing in urban slums in Haridwar, India; A Comparative Implementation Study

In many parts of the world, including India, a silent virus called hepatitis C often hides inside the body without causing immediate symptoms. If left undetected, this virus can slowly damage the liver over many years. For decades, the standard way to find this virus has been to visit a clinic or hospital, where a doctor draws a small amount of blood and sends it to a laboratory. This method works well for some people, but it leaves many others behind, particularly those living in crowded urban neighborhoods where daily life makes it difficult to travel to a medical center. To solve this, health experts have recently suggested a different approach: self-testing. This involves giving a person a simple kit they can use at home or in a clinic to check for the virus themselves, removing the need for a long wait or a trip to a specialist. The question remains, however, whether people will actually use these kits if they are offered, and whether bringing the test to the community works better than waiting for people to come to the clinic.

A recent study in the city of Haridwar, India, set out to answer these questions by testing two different ways of offering these self-tests to people living in urban slums. The researchers worked between July 2023 and August 2024 across three different neighborhoods, each managed by a local primary health center. In one neighborhood, they set up a system where trained staff offered the self-test kits to patients who were already visiting the clinic for other reasons. In a second neighborhood, the approach was reversed: trained workers and community health volunteers went directly into the homes of families, selected through a specific grid system, to offer the kits there. A third neighborhood served as a control, where people received the usual standard of care, which meant they had to rely on the existing, less active system of finding the virus. The goal was to see how many people were reached by these new methods and how many of those people actually agreed to take the test.

The results showed a clear difference in how well the two new methods worked compared to the old way. In the neighborhood where the kits were offered at the clinic, the staff managed to reach about eighteen percent of the people walking through the doors. In the neighborhood where workers went door-to-door, they reached about fourteen percent of the households. While the clinic method reached slightly more people overall, the home-based method proved more successful at convincing people to actually use the kit. When the kits were offered at home, nearly seventy-two percent of the people accepted them and took the test. In contrast, at the clinic, only about fifty-eight percent of those offered a kit decided to use it. This suggests that for people living in these crowded communities, having the option to test in the privacy of their own home removes a barrier that a busy clinic visit cannot.

Despite the success in getting people to test, the study also revealed a sobering reality about the virus itself in this specific population. Out of the 465 people who took the self-tests, only five tested positive for the virus. This low number indicates that while self-testing is excellent at reaching people who might otherwise never get tested, simply offering the test to everyone in a general neighborhood might not find many cases if the virus is not widespread in that specific group. The researchers also noticed that men were significantly less likely to accept a test than women, and people offered a test at a clinic were almost twice as likely to refuse it compared to those offered one at home.

The study concludes that while self-testing is a powerful tool to expand access to hepatitis C screening in urban slums, it is not a magic bullet that solves the problem on its own. The home-based model was particularly effective at getting people to accept the test, but the low number of positive results suggests that these tests might need to be targeted more carefully toward groups known to be at higher risk, rather than offered to everyone in a general neighborhood. The work confirms that national policies to screen for the virus are not being followed through in routine clinic visits, but it also shows that bringing the test to people's doorsteps can change that behavior, even if the virus itself remains rare in the general population.