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Background:
Conducting research on Hepatitis C Virus Self-Testing (HCVST) among high-risk populations presents unique challenges, particularly when engaging people who inject drugs (PWIDs) and people who use drugs (PWUDs). While these populations are at elevated risk for HCV, recruiting and managing participants with substance use disorders introduces logistical, ethical, and safety concerns for research staff.
Methods:
Our organization has conducted three studies on HCV self-testing, recruiting from the general population and key populations, including PWIDs, PWUDs, men who have sex with men (MSM), and sex workers. One prospective observational study in South Africa recruited 1,567 participants, with 998 self-test positives and 854 PCR-confirmed cases. Two additional studies evaluated the usability and performance of HCV self-tests, recruiting 1,404 and 594 participants, yielding 91 and 134 positives, respectively. Despite inclusion criteria prohibiting intoxicated participants, recruiters strategically engage PWIDs early in the morning before drug use.
Results:
Research staff face significant challenges when working with high-risk populations. PWIDs often experience agitation due to withdrawal, hunger, and homelessness, requiring vigilant security measures. Theft attempts from research rooms are common, and participants frequently express distress over food insecurity despite study reimbursements. Blood sample collection is complicated by collapsed veins and dehydration, necessitating multiple attempts. These challenges contribute to heightened stress among research staff.
Conclusion:
To ensure the well-being of both participants and research staff, tailored training programs on hepatitis C research and harm reduction strategies should be developed by health authorities. Additionally, mental health support for research staff is essential to mitigate the psychological strain associated with working with vulnerable populations. Implementing these measures will enhance study outcomes and improve engagement with high-risk groups.
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