Centre for International Health Protection, Robert Koch Institute, Berlin, Germany.
National University of Kyiv-Mohyla Academy, Kyiv, Ukraine.
BMC Public Health. 2024 Jun 3;24(1):1482. doi: 10.1186/s12889-024-18953-5.
In the World Health Organization European Region, an estimated 14 million people live with a chronic hepatitis B virus infection (HBV), and 12 million are affected by a hepatitis C virus infection (HCV). Uzbekistan bears a major burden of HBV and has one of the highest HCV prevalence in the region. Following a presidential decree in May 2022, significant funds were allocated to the viral hepatitis (VH) elimination program in Uzbekistan. The program expands VH testing to reach 500,000 people annually during 2022-2025 as part of the VH elimination strategy that includes the provision of free testing and affordable treatment. Exploring the existing barriers and facilitators to VH testing is pivotal for informing these interventions.
This study uses a cross-sectional qualitative design to identify and explore the barriers and facilitators to VH testing among the general population in Uzbekistan. We collected data during October-November 2022 through semi-structured interviews with 12 key informants (KIs) and 7 focus group discussions with two target populations: the general population and healthcare workers (HCW) in Tashkent, Uzbekistan.
Following the capability-opportunity-motivation-behavior model (COM-B model) as a framework for the analysis, we identified major capability barriers to VH testing primarily linked to low health literacy and limited knowledge about VH types, symptoms, transmission, testing and treatment. Physical opportunity barriers included the time and financial costs associated with testing, diagnostics, and treatment. Sociocultural opportunity barriers involved anticipated negative reactions and stigmatization, particularly affecting women. Motivational barriers included a reluctance to be tested when asymptomatic and a general fear of receiving positive test results. The involvement of healthcare workers in promoting VH awareness and motivating the general population emerged as a facilitator.
A multi-pronged approach is recommended to achieve VH testing goals among the general population, focusing on raising awareness and health literacy and creating an enabling environment that ensures easy accessibility and minimizing VH testing-associated costs.
在世界卫生组织欧洲区域，估计有 1400 万人患有慢性乙型肝炎病毒（HBV）感染，1200 万人患有丙型肝炎病毒（HCV）感染。乌兹别克斯坦承担着 HBV 的主要负担，是该区域 HCV 发病率最高的国家之一。2022 年 5 月，根据总统令，乌兹别克斯坦为病毒性肝炎（VH）消除规划划拨了大量资金。该规划扩大了 VH 检测范围，计划在 2022 年至 2025 年期间，每年对 50 万人进行检测，作为 VH 消除战略的一部分，该战略包括提供免费检测和负担得起的治疗。探索 VH 检测的现有障碍和促进因素对于为这些干预措施提供信息至关重要。
本研究采用横断面定性设计，以确定和探讨乌兹别克斯坦普通人群中 VH 检测的障碍和促进因素。我们于 2022 年 10 月至 11 月期间通过与 12 名关键知情人（KIs）的半结构式访谈以及在乌兹别克斯坦塔什干的两个目标人群（普通人群和卫生保健工作者）进行的 7 次焦点小组讨论收集数据。
根据能力-机会-动机-行为模型（COM-B 模型）作为分析框架，我们确定了 VH 检测的主要能力障碍，主要与低健康素养以及对 VH 类型、症状、传播、检测和治疗的知识有限有关。物理机会障碍包括与检测、诊断和治疗相关的时间和经济成本。社会文化机会障碍涉及预期的负面反应和污名化，这尤其影响妇女。动机障碍包括在无症状时不愿意接受检测以及对获得阳性检测结果的普遍恐惧。卫生保健工作者参与提高 VH 意识和激励普通人群的工作，被认为是一个促进因素。
建议采取多管齐下的方法来实现普通人群的 VH 检测目标，重点是提高认识和健康素养，创造一个有利的环境，确保轻松获得并尽量减少 VH 检测相关成本。
