Acceptability of Hepatitis C virus self-testing among people who use cocaine or crack in Costa Rica

Background: Hepatitis C virus (HCV) is a significant public health concern in Latin America. Regional studies show that only 14% of cases are diagnosed, and less than 15% receive treatment. In Costa Rica, HCV prevalence data is scarce. A study in 1995 among blood donors showed a prevalence of 0.24%. Another study in 2013 among homeless people found no HCV cases but showed high-risk practices in the population. This study aims to explore the knowledge, perceptions, and preferences of people who use cocaine or crack in Costa Rica regarding HCV and HCV self-testing.

Methods: Qualitative-based study with 49 participants. Mean age was 43 years old, 23 were men and 26 women (16 cis female, 10 trans female, and 23 cis men). They were recruited by convenience sampling, snowballing, and contact with community-based organizations. Data was collected through individual interviews (n=15), group interviews (n=14), and Participatory Action Research sessions (n=20). Information was analyzed using thematic analysis method.

Results: Knowledge of HCV among participants is very poor, though risk perception is high, particularly among those sharing drug paraphernalia or engaging in sex work. Most participants support HCV self-testing, citing reduced stigma and increased autonomy as key benefits. Concerns include improper use of the device and the need for confirmatory testing. Barriers for testing and treatment include financial constraints, lack of social security, and fear of stigma and mistreatment in health services.

Conclusions: HCV self-testing is highly acceptable among people who use cocaine or crack in Costa Rica. However, the country lacks a comprehensive plan or program to address HCV, and knowledge about the virus remains very low among key populations. Implementation should be accompanied by educational campaigns and healthcare provider training to reduce stigma. Community-based organizations play a critical role ensuring improved access to testing, confirmatory diagnosis, and treatment.