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Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：在世界卫生组织欧洲地区，估计有1400万人患有慢性乙型肝炎病毒感染（HBV），1200万人受到丙型肝炎病毒感染（HCV）的影响。乌兹别克斯坦承担着HBV的主要负担，并且是该地区HCV患病率最高的国家之一。根据2022年5月的总统令，乌兹别克斯坦为病毒性肝炎（VH）消除计划分配了大量资金。作为VH消除战略的一部分，该计划在2022年至2025年期间将VH测试扩展到每年50万人，其中包括提供免费测试和负担得起的治疗。探索VH测试的现有障碍和促进因素对于告知这些干预措施至关重要。
方法：本研究使用横断面定性设计来识别和探索乌兹别克斯坦普通人群中VH测试的障碍和促进因素。我们在2022年10月至11月期间通过对12名关键线人（KIs）的半结构化访谈和与两个目标人群的7个焦点小组讨论收集了数据：塔什干的普通人群和医护人员（HCW）。乌兹别克斯坦。
结果：遵循能力-机会-动机-行为模型（COM-B模型）作为分析框架，我们确定了VH测试的主要能力障碍，主要与健康素养低和对VH类型的知识有限有关，症状,传输,测试和治疗。物理机会障碍包括与测试相关的时间和财务成本，诊断,和治疗。社会文化机会障碍涉及预期的负面反应和污名化，尤其影响女性。动机障碍包括无症状时不愿意接受测试，以及普遍担心收到阳性测试结果。医护人员参与提高VH意识和激励普通人群成为促进者。
结论：建议多管齐下的方法来实现一般人群中的VH测试目标，专注于提高认识和健康素养，并创造一个有利的环境，以确保易于获取并最大程度地减少VH测试相关成本。
方法：本研究使用横断面定性设计来识别和探索乌兹别克斯坦普通人群中VH测试的障碍和促进因素。我们在2022年10月至11月期间通过对12名关键线人（KIs）的半结构化访谈和与两个目标人群的7个焦点小组讨论收集了数据：塔什干的普通人群和医护人员（HCW）。乌兹别克斯坦。
结果：遵循能力-机会-动机-行为模型（COM-B模型）作为分析框架，我们确定了VH测试的主要能力障碍，主要与健康素养低和对VH类型的知识有限有关，症状,传输,测试和治疗。物理机会障碍包括与测试相关的时间和财务成本，诊断,和治疗。社会文化机会障碍涉及预期的负面反应和污名化，尤其影响女性。动机障碍包括无症状时不愿意接受测试，以及普遍担心收到阳性测试结果。医护人员参与提高VH意识和激励普通人群成为促进者。
结论：建议多管齐下的方法来实现一般人群中的VH测试目标，专注于提高认识和健康素养，并创造一个有利的环境，以确保易于获取并最大程度地减少VH测试相关成本。
