Challenges (number of respondents highlighting issue) | Proposed interventions (number of respondents highlighting issue) |
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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) |