Assessing hepatitis C self-testing within differentiated care models in Cameroon: Feasibility, acceptability, and linkage to care for key and priority populations.

Hepatitis C virus (HCV) infection remains a global public health concern, with limited care coverage in resource-limited settings. HCV self-testing (HCVST) offers a potential strategy to expand screening, diagnosis, and treatment. This study evaluated the feasibility and acceptability of HCVST among at-risk populations in Cameroon. Between 26-06-2023 and 01-03-2024, adults (≥21 years) were recruited through four HCVST service models targeting specific populations: people living with HIV at antiretroviral therapy clinics, men who have sex with men and people who inject drugs at drop-in-centers, and adults ≥45 years attending chronic disease clinics. Participants were randomly assigned either blood-based or oral-fluid self-test kits, with the option to test on-site or off-site, with or without assistance. Reactive results were linked to confirmatory testing and HCV treatment. Descriptive and multivariable analyses assessed acceptability and feasibility outcomes of HCVST. Of 2,653 clients offered HCVST, 99.7% (n = 2,644) accepted, 97.7% tested on-site, and 80.9% performed unassisted self-testing. Most (91.7%) found HCVST easy to use, citing rapid results (60.4%), simplicity (45.8%), and confidentiality (23.1%). Nearly all (98.7%) would recommend HCVST, with 45.9% favoring unassisted home-testing. Satisfaction with HCVST varied by care model, increased with higher HCV knowledge (aOR 1.07, 1.04-1.11), and decreased for retired clients (aOR 0.65, 0.44-0.96), blood-based tests (aOR 0.59, 0.50-0.70) and assisted testing (aOR 0.32, 0.25-0.40). Difficulties in result interpretation were rare (3.1%) but higher with off-site testing (aRR 3.76, 1.69-8.36). The HCVST seroprevalence was 4.4% (n = 117), highest at chronic disease clinics (12.2%). Among 117 clients with reactive results, 93.2% linked to confirmatory testing, 72 were treatment-eligible, and 71 (98.6%) initiated therapy, with 74.6% achieving cure. Men had greater attrition along the care cascade (aOR: 3.77, 1.10-12.91). HCVST was highly acceptable and feasible, increasing testing uptake and care engagement in Cameroon. Findings can guide rollout through differentiated, population-specific delivery models.