Awareness and Perception of Hepatitis C Self-Testing in Nigeria: A National Survey of Stakeholders and the Public

Abstract

Background: Hepatitis C virus (HCV) infection presents a significant public health challenge globally, particularly in high-burden countries like Nigeria, where an estimated 2.4 million individuals are living with HCV. HCV self-testing (HCVST) can potentially bridge the significant diagnosis gap and help individuals to determine their HCV status in the privacy of their homes. It offers a solution to overcome barriers related to stigma and limited access to healthcare. In Nigeria, Self-testing for hepatitis C has only been implemented in a pilot research context. This study aimed to assess stakeholder and community awareness and perceptions of HCVST in Nigeria. The findings will provide insights that could inform effective policies and future scale-up programs for HCV control. Methods: A cross-sectional descriptive study was conducted using an online social media survey administered through SurveyMonkey. The survey was disseminated across social media platforms and groups between October–November 2023. Participants included Nigerians (both health professionals and non-health professionals) aged 18 years or older residing in any of the 36 states and the Federal Capital Territory (FCT). Data collected include sociodemographic characteristics, awareness and perceptions of HCVST, and perceived benefits and barriers. Results: Of 321 respondents, 94% perceived HCVST as highly important. While 77% of respondents knew about HIVST, only 58% had prior knowledge of HCVST. The analysis also showed that healthcare workers had greater awareness of HIV self-testing (82.3%) compared to non-healthcare workers (50.0%). Most respondents (88%) were highly likely to recommend HCVST and perceived it as a cost-effective alternative to traditional testing. Key perceived benefits included increased disease detection and control (67%), improved access to testing (21%), and reduced stigma (11%). In the unadjusted model, geographical zone (Southern Nigeria: cOR = 0.49, 95% CI: 0.30–0.77, p = 0.002), work experience (more than 20 years: cOR = 2.79, 95% CI: 1.11–8.07, p = 0.039), and prior awareness of HIV self-testing (cOR = 5.24, 95% CI: 3.00–9.43, p < 0.001) were significant predictors of HCVST awareness. However, in the adjusted model, only prior awareness of HIV self-testing remained significant (aOR = 4.77, 95% CI: 2.62–8.94, p < 0.001). Conclusions: The strong support for HCVST among stakeholders in Nigeria highlights its potential to enhance HCV control, especially within the broader context of infectious diseases like STIs. The greater awareness of HIV self-testing among healthcare workers compared to non-healthcare workers indicates the need for targeted awareness campaigns for non-healthcare populations. Addressing these awareness gaps, leveraging lessons from HIVST, and using existing infrastructure will be crucial. Prioritizing public education, outreach, and effective linkage to care will drive the impact of HCVST in achieving HCV elimination goals and position it as a model for expanding similar STI interventions in Nigeria.

1. Introduction

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease, cirrhosis, and liver cancer and presents a significant public health challenge globally [1,2]. Though blood is the main route whereby HCV spreads, sexual transmission—especially among men who have sex with men (MSM) and HIV-positive people—is becoming a major concern [3,4]. In the larger context of sexual health, efficient HCV testing strategies are vital, considering the potential for sexual transmission and the high prevalence of HCV among key populations affected by STIs. Hence, there is need for innovative testing modalities and awareness campaigns focusing on HCV within the wider scope of sexual health. In April 2024, the World Health Organization (WHO) reported that only 36% (18 million) of the 50 million people living with HCV globally knew their status in 2022 [2]. This highlights a vast HCV diagnosis gap, more pronounced in the WHO African Region. In 2021, the WHO recommended that HCVST should be offered as an additional approach to HCV testing [5]. HCV self-testing (HCVST) offers a promising solution to address the diagnosis gap by empowering individuals to discreetly determine their HCV status in the comfort and privacy of their homes. This could potentially help them overcome the barriers related to stigma, discrimination, and limited healthcare access that hinder traditional facility-based testing. Despite the transformative and revolutionary advent of direct-acting antivirals (DAAs) for HCV treatment in 2014 [6], the report released by the World Health Organization reveals a significant gap in HCV awareness and treatment [2]. This gap is particularly pronounced in high-burden countries like Nigeria, where an estimated 2.4 million individuals are living with HCV, according to the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) [7]. In July 2024, the World Health Organization announced the prequalification of the first oral HCVST, manufactured by OraSure Technologies [8]. This further underscores the potential for a nationwide rollout of HCVST in Nigeria and globally, moving beyond pilot implementations. While HCVST has been implemented in pilot research projects funded by Unitaid in Nigeria and the first Nigeria HCVST guideline was launched in April 2024, routine program implementation has not yet begun [9]. The need for improved HCV testing strategies in Nigeria is evident. While the success of HIV self-testing (HIVST) in Nigeria offers a promising model, the potential of HCV self-testing (HCVST) remains unexplored.

Recent studies have demonstrated the usability and acceptability of HCVST in various populations [10,11,12,13,14,15,16]. However, the successful implementation and scaling up of HCVST in Nigeria necessitates a detailed understanding of stakeholder and community/public perspectives. Prior research in Nigeria has explored various aspects of HIV self-testing (HIVST). For example, some studies from Nigeria assessed knowledge and acceptability of HIVST among university students [17,18]. The studies found good knowledge but also concerns about accuracy and potential risk of coercion [17,18]. Another early study from Nigeria examined stakeholder opinions prior to HIVST introduction [19]. The study also revealed concerns among policymakers about potential social harms and stigma [19]. However, there is a lack of research specifically focused on HCVST in Nigeria. This study aimed to address this gap by investigating stakeholder and public perceptions of HCVST, including perceived benefits, barriers, and implementation strategies. By identifying perceived benefits, barriers, and potential implementation strategies, this research will inform the development of effective policies and scale-up programs, and will ultimately contribute to the elimination of HCV in Nigeria.

2. Materials and Methods

Study Design and Setting: This is a cross-sectional descriptive study. Between October–November 2023, data were collected using an online social media survey administered through SurveyMonkey. The survey leveraged various social media platforms such as LinkedIn, WhatsApp, Facebook, and Twitter to reach participants nationwide.

Study Size: Based on a sample size calculation using a 5% margin of error, a 95% confidence level, and an estimated proportion of 54.8% from previous studies supporting HIV self-testing [19], the required sample size was determined to be 381 participants. However, the final number of respondents was 321. Although this is slightly lower than the originally calculated sample size, the achieved sample still provides a reasonable level of precision for detecting significant differences and trends. Furthermore, statistical power calculations suggest that the reduced sample size maintains adequate power to derive meaningful conclusions regarding stakeholder and community awareness and perceptions of HCVST.

Sampling Technique: A non-random, convenience sampling technique was used due to the online nature of the survey. The survey link was widely disseminated across social media platforms to maximize the reach and inclusivity.

Study Participants: Participants included Nigerians aged 18 years or older residing in any of the 36 states and the Federal Capital Territory (FCT). Nigeria was divided into north and south regions for a more representative sampling to account for potential regional variances that may result from socio-cultural differences between these regions. Both health and non-health professionals working in the public health or related sectors were invited to participate. The composition of the sample included participants from various professional backgrounds, including clinicians, community advocates, NGO workers, and researchers. Given this diversity, the perspectives presented in this study may vary considerably, as the experiences and views of a clinician may differ significantly from those of, for instance, a community advocate or a lawyer.

Inclusion and Exclusion Criteria: To be included in the study, each participant must be a Nigerian resident aged 18 years or older; be willing to provide informed consent electronically; have access to the internet and be able to complete an online survey. Individuals younger than 18 years, non-residents of Nigeria, and those unable or unwilling to provide informed consent were excluded from the study.

Variables: The primary variables of interest included the following: sociodemographic characteristics (age, gender, educational level, geographical zone), professional background and work experience in the health sector, awareness and perceptions of HCVST and HIV self-testing, perceived benefits and barriers of HCVST and willingness to recommend HCVST.

Data Sources/Measurement: Data were collected through a structured questionnaire developed on SurveyMonkey. The questionnaire included sections on sociodemographic information, professional experience, and awareness and perceptions of HCVST. Skip logic was used to exclude ineligible participants. Only those that met the inclusion criteria completed the survey. The questionnaire used for data collection was developed based on findings from previous studies on self-testing for infectious diseases. To ensure reliability and content validity, the questionnaire was reviewed by experts in public health and infectious disease. It was also pre-tested with a small group of healthcare professionals and community members (n = 20) so it could be assessed for clarity and comprehensiveness. Feedback from the pre-test was used to adjust the tool and make it contextually appropriate for the Nigerian population, minimize measurement errors, and enhance the accuracy of the collected data.

Bias: To mitigate bias, the survey was disseminated across multiple social media platforms (WhatsApp, Facebook, LinkedIn, Twitter/X, etc.) to reach a diverse audience. In addition, the questionnaire was designed to be neutral and unbiased in its language. However, as an online survey, there may be inherent biases related to internet access and self-selection.

Data Collection: Data collection took place between October and November 2023. Participants were required to sign an electronic informed consent form before proceeding to the survey. The survey link was shared widely through social media platforms to maximize participation.

Data Analysis: Data were exported from SurveyMonkey into SPSS (version 25) for analysis. The main quantitative variable in this study, age, was assessed for normality using the Kolmogorov–Smirnov test before analysis. The test showed that age was not normally distributed, so we documented age as Median (IQR) in

Table 1. Sociodemographic characteristics of the respondents.

Characteristic	Frequency (%)
1 Age in Years	33 (28, 40)
Gender
Female	141 (44%)
Male	180 (56%)
Age Group
18–25 years	40 (12%)
26–30 years	73 (23%)
31–35 years	84 (26%)
36–40 years	55 (17%)
41 and above	69 (21%)
Educational Level
No Formal Education	1 (0.3%)
Secondary Education	5 (1.6%)
Tertiary Education	212 (66%)
Postgraduate Education	103 (32%)
Role Description
Clinician	123 (38%)
Community Advocate	99 (31%)
Development Sector/NGO Worker	59 (18%)
Researcher	40 (12%)
Geopolitical Zone
North Central	37 (12%)
North-East	6 (1.9%)
North-West	86 (27%)
South-East	42 (13%)
South-South	20 (6.2%)
South-West	130 (40%)
Zone
Northern Nigeria	129 (40%)
Southern Nigeria	192 (60%)

¹ Median (IQR); n = 321.

. Based on this outcome, we employed non-parametric inferential statistics, including binary logistic regression and Chi-square tests, as these do not assume a normal distribution for the variables. Descriptive statistics, such as frequencies and percentages were used to summarize the sociodemographic characteristics and perceptions of the participants. Missing data were handled by performing a complete case analysis; only participants with fully completed responses were included in the final analysis.

Ethical Considerations: Approval for the study was obtained from the National Health Research Ethics Committee (NHREC) with the following assigned protocol approval number: NHREC/01/01/2007. Informed consent was obtained electronically from all participants, and strict confidentiality was maintained throughout the study.

3. Results

The sociodemographic characteristics of the study participants indicated a median age of 33 years. Most respondents (26%) were within the age group of 31–35 years (Table 1). In addition, most respondents had tertiary education (66%) and were males (56%). The majority of respondents (40%) were from the Southwest zone. When categorized broadly, 60% of respondents were from Southern Nigeria, and 40% were from Northern Nigeria.

Most respondents (82.6%) were involved in professional roles within the health sector (Figure 1 and Figure 2). Among the different roles, clinicians (87%) and Development Sector/NGO workers (97%) have the highest levels of engagement within the health sector. In contrast, 30.3% and 20.0% of community advocates and researchers are not engaged in the health sector.

Figure 2 summarizes respondents’ professional healthcare experience and prior awareness of self-testing for hepatitis C and HIV. Over three-quarters of the respondents were aware of HIV self-testing before the survey, while about half of the respondents knew about hepatitis C self-testing, and only 34% of respondents had prior experience with hepatitis C self-testing. In addition, among healthcare workers, 82.3% reported prior awareness of HIV self-testing, compared to 50.0% of non-healthcare workers.

Table 2. Respondents’ perceptions about hepatitis C self-testing in Nigeria.

Characteristic	Frequency 1
Importance of Introducing Hepatitis C Self-Testing in Nigeria
Very important	302 (94%)
Somewhat important	12 (3.7%)
Don’t know	5 (1.6%)
Not very important	2 (0.6%)
Benefits of Hepatitis C Self-Testing to Nigeria Health System
Increase disease detection and control	216 (67%)
Increased access to testing	68 (21%)
Reduce stigma associated with testing	36 (11%)
Others	1 (0.3%)
Likelihood to Recommend Hepatitis C Self-Testing
Very likely	282 (88%)
Somewhat likely	28 (8.7%)
Don’t know	6 (1.9%)
Not very likely	3 (0.9%)
Not at all likely	2 (0.6%)
Importance of Linkage and Treatment with Hepatitis C Self-Testing
Very important	292 (91%)
Somewhat important	21 (6.5%)
Don’t know	8 (2.5%)
Inclusion of HCVST as an Option for Screening/Testing for Hepatitis in Nigeria
Very important	289 (90%)
Somewhat important	27 (8.4%)
Don’t know	2 (0.6%)
Not very important	2 (0.6%)
Not at all important	1 (0.3%)
HCVST as a Cost-Effective Alternative to Traditional Testing Methods
Yes	258 (80%)
No	63 (20%)
Impact of HCVST on the Stigma Associated with Hepatitis C in Nigeria
Reduce Stigma	263 (82%)
Don’t know	26 (8.1%)
Increase Stigma	16 (5.0%)
No impact	16 (5.0%)
Use of HCVST as a Tool to Reach Underserved Populations in Nigeria
Yes	270 (84%)
Don’t know	31 (9.7%)
No	20 (6.2%)

¹ n (%); n = 321; HCVST = hepatitis C self-testing.

is the summary of respondents’ perceptions regarding hepatitis C self-testing in Nigeria. Respondents expressed favorable perceptions regarding hepatitis C self-testing in Nigeria.

The majority of respondents (94%) considered introducing HCVST in Nigeria “very important”. Most respondents (67%) regarded increased disease detection and control as the primary benefit, and 88% were very likely to recommend HCVST. Furthermore, 91% rated the importance of linking HCVST with treatment as “very important”, while 90% felt that HCVST should be included as an option for screening and testing. Moreover, 80% agreed that HCVST is a cost-effective alternative to traditional methods. Regarding stigma, 82% believed that HCVST could reduce stigma associated with hepatitis C, and 84% agreed that it could effectively reach underserved populations.

Table 3. Respondents’ perceptions about hepatitis C self-testing categorized by zones in Nigeria.

Characteristic	1 Northern Nigeria, (n = 129)	1 Southern Nigeria, (n = 192)	p-Value 2
Importance of Introducing Hepatitis C Self-Testing in Nigeria			0.61
Very important	124 (96%)	178 (93%)
Somewhat important	4 (3.1%)	8 (4.2%)
Don’t know	1 (0.8%)	4 (2.1%)
Not very important	0 (0%)	2 (1.0%)
Benefits of Hepatitis C Self-Testing to Nigeria Health System			0.54
Increase disease detection and control	85 (66%)	131 (68%)
Increased access to testing	26 (20%)	42 (22%)
Reduce stigma associated with testing	18 (14%)	18 (9.4%)
Others	0 (0%)	1 (0.5%)
Likelihood to Recommend Hepatitis C Self-Testing			0.18
Very likely	117 (91%)	165 (86%)
Somewhat likely	7 (5.4%)	21 (11%)
Don’t know	4 (3.1%)	2 (1.0%)
Not very likely	1 (0.8%)	2 (1.0%)
Not at all likely	0 (0%)	2 (1.0%)
Importance of Linkage and Treatment with HCVST			0.021
Very important	124 (96%)	168 (88%)
Somewhat important	3 (2.3%)	18 (9.4%)
Don’t know	2 (1.6%)	6 (3.1%)
HCVST Inclusion as an Option for Hepatitis testing in Nigeria			>0.99
Very important	116 (90%)	173 (90%)
Somewhat important	11 (8.5%)	16 (8.3%)
Don’t know	1 (0.8%)	1 (0.5%)
Not very important	1 (0.8%)	1 (0.5%)
Not at all important	0 (0%)	1 (0.5%)
HCVST as a Cost-Effective Alternative to Traditional Testing Methods in Nigeria	101 (78%)	157 (82%)	0.48
Impact of HCVST on the Stigma Associated with Hepatitis C			0.023
Reduce Stigma	113 (88%)	150 (78%)
Don’t know	8 (6.2%)	18 (9.4%)
Increase Stigma	7 (5.4%)	9 (4.7%)
No impact	1 (0.8%)	15 (7.8%)
Use of HCVST as a Tool to Reach Underserved Populations			0.52
Yes	105 (81%)	165 (86%)
Don’t know	15 (12%)	16 (8.3%)
No	9 (7.0%)	11 (5.7%)

¹ n (%); ² Fisher’s exact test; Pearson’s Chi-squared test; HCVST = hepatitis C self-testing.

shows the summary of respondents’ perceptions about hepatitis C self-testing in Nigeria.

Most respondents from both regions (96% in the North, 93% in the South) viewed introducing HCVST as very important. The majority saw increased disease detection and control as the primary benefit (66% in the North, 68% in the South). Also, 91% of respondents in the North and 86% in the South were very likely to recommend HCVST. Both regions/geopolitical zones supported including HCVST as a screening option. About 90% of participants from each region considered HCVST very important. A large majority (78% in the North, 82% in the South) found HCVST cost-effective, and 81% in the North and 86% in the South believed it could reach underserved populations. However, significant differences emerged regarding linkage to treatment and stigma reduction. In the North, 96% rated linkage to treatment as very important, compared to 88% in the South (p = 0.021). Regarding stigma, 88% of Northern respondents believed HCVST would reduce stigma, while only 78% from the South agreed (p = 0.023).

Table 4. Association between sociodemographic characteristics and awareness of HCV self-testing.

Characteristic	COR 1	95% CI 1	p-Value	AOR 2	95% CI 2	p-Value
Age Group
18–25 years	Ref	Ref		Ref	Ref
26–30 years	0.98	0.45, 2.13	>0.9	0.75	0.31, 1.76	0.5
31–35 years	1.55	0.72, 3.33	0.3	1.19	0.48, 2.91	0.7
36–40 years	1.26	0.55, 2.87	0.6	0.67	0.23, 1.92	0.5
41 and above	1.41	0.64, 3.10	0.4	0.53	0.17, 1.62	0.3
Gender
Female	Ref	Ref		Ref	Ref
Male	1.28	0.82, 2.00	0.3	1.17	0.69, 1.98	0.6
Role Description
Clinician	Ref	Ref		Ref	Ref
Community Advocate	0.59	0.34, 1.01	0.054	0.60	0.32, 1.10	0.10
Development Sector/NGO Worker	0.84	0.45, 1.60	0.6	0.88	0.43, 1.79	0.7
Researcher	0.78	0.38, 1.63	0.5	0.76	0.35, 1.70	0.5
Zone
Northern Nigeria	Ref	Ref		Ref	Ref
Southern Nigeria	0.49	0.30, 0.77	0.002	0.60	0.34, 1.07	0.086
Work Experience in Health Sector (Years)
1–5	Ref	Ref		Ref	Ref
6–10	1.42	0.76, 2.70	0.3	1.03	0.49, 2.21	>0.9
11–20	1.14	0.61, 2.18	0.7	1.07	0.43, 2.71	0.9
Over 20	2.79	1.11, 8.07	0.039	2.70	0.75, 10.6	0.14
Not Working in Health Sector	0.49	0.25, 0.94	0.034	0.73	0.34, 1.55	0.4
Awareness of HIV Self-Testing Before Now
No	Ref	Ref		Ref	Ref
Yes	5.24	3.00, 9.43	<0.001	4.77	2.62, 8.94	<0.001

¹ COR = Crude Odds Ratio, ² AOR = Adjusted Odds Ratio, CI = Confidence Interval.

shows the associations between sociodemographic characteristics and awareness of HCV self-testing (HCVST) in Nigeria, analyzed using both bivariate and multivariate models. In the unadjusted analysis, awareness of HCVST was significantly associated with the geographical zone, work experience, and prior awareness of HIV self-testing. Respondents from Southern Nigeria were less likely to be aware of HCVST compared to those from Northern Nigeria (COR = 0.49, 95% CI: 0.30, 0.77, p = 0.002). Those with over 20 years of work experience were more likely to be aware (COR = 2.79, 95% CI: 1.11, 8.07, p = 0.039), and those who had prior awareness of HIV self-testing were over five times more likely to be aware of HCVST (COR = 5.24, 95% CI: 3.00, 9.43, p < 0.001). In the adjusted model, only prior awareness of HIV self-testing remained significant. Respondents previously aware of HIV self-testing were nearly five times more likely to be aware of HCVST (AOR = 4.77, 95% CI: 2.62, 8.94, p < 0.001). Geographical zone, work experience, age, gender, and role descriptions were not significant predictors in the adjusted analysis. The adjusted odds ratios for these variables did not show meaningful associations, with p-values above 0.10.

4. Discussion

This study explored stakeholder awareness and perceptions of HCV self-testing in Nigeria. It provides crucial insights into both strengths and weaknesses in current HCV control and prevention strategies. By considering the views of a wide range of stakeholders, the study makes a significant contribution to the dialogue around self-testing for infectious diseases, particularly in high-burden settings like Nigeria.

We gathered responses from 30 states in Nigeria—15 from the North, including the FCT, and 15 from the South. This geographic representation provided insights into regional differences in awareness. Although we included perspectives from various professional backgrounds, the investigators acknowledged that healthcare workers were overrepresented. Therefore, these results may reflect the views of more educated and less vulnerable populations.. Nevertheless, the finding that 94% of respondents considered HCVST highly important underscores broad recognition of its benefits and aligns with global goals to close the HCV diagnosis gap [2].

We observed a critical gap in awareness between HCVST and HIV self-testing (HIVST), similar to earlier studies [20,21]. While 77% of respondents knew about HIVST, only 58% had prior knowledge of HCVST. Our analysis also showed that healthcare workers had greater awareness of HIV self-testing (82.3%) compared to non-healthcare workers (50.0%). This finding highlights the need for targeted campaigns for non-healthcare populations. This difference points to a clear need for educational outreach specifically focused on HCVST. Leveraging the existing infrastructure and familiarity with HIVST could help bridge this gap. The more widespread awareness of HIVST is likely due to its longer history of introduction in Nigeria (since 2018) and more extensive implementation in Nigeria [17,18,19], unlike HCVST, which was only officially deployed for pilot implementation research in 2023.

The multivariate analysis offered further insights into factors influencing awareness of HCVST. In the unadjusted model, we found that respondents from Southern Nigeria, those with over 20 years of work experience, and those aware of HIVST were more likely to be aware of HCVST. However, after adjusting for other variables, only prior awareness of HIVST remained a significant predictor. This finding highlights the role of HIVST awareness in driving HCVST uptake. Policymakers could effectively increase awareness by integrating HCVST into existing HIVST programs. Using established communication channels, training programs, and distribution networks would optimize resources and create synergies for both HIV and HCV testing. To support this, the integration of HCVST into national health strategies should include joint technical working groups, shared awareness campaigns, and coordinated monitoring strategies, as recommended by Nigeria’s National HCVST 2023 guidelines [9].

Support for HCVST among stakeholders was also high. About 88% of respondents indicated they would recommend HCVST. This favorable perception aligns with findings from other studies on the acceptability and feasibility of HCVST [10,11]. Participants recognized the benefits of HCVST for improving disease detection, expanding access, and reducing stigma. However, challenges remain regarding test accuracy, user comprehension, and ensuring effective linkage to care. A significant majority of respondents (91%) stressed the need for linking individuals who self-test to appropriate care and treatment services. Effective linkage is critical, as self-testing alone cannot improve public health outcomes without integration into the broader continuum of care. Experiences from HIVST programs have shown that successful linkage to care is essential for program success [19,21,22,23,24,25,26,27,28].

HCV self-testing kits, when accessible could also help to reduce stigma. However, these kits rely on antibody-based detection, which indicates possible exposure rather than a definitive diagnosis. Traditional diagnostic methods, like HCV-RNA quantification using qRT-PCR, remain necessary for confirmation [29]. Those who test positive with an HCV self-test would undergo further testing to determine viral load and active infection. Methods for confirmatory testing include the HCV cAg test, the HCV Ab-LIA test, or the qRT-PCR test. These additional steps are crucial for accurate diagnosis and treatment. Although HCV is primarily transmitted through blood, sexual transmission also plays a role, especially among certain populations such as men who have sex with men (MSM) who are co-infected with HIV. The implications of HCVST for these populations are significant. Self-testing can help identify infections early and control them, thereby reducing further sexual transmission risks. Expanding access to HCVST in these populations could therefore play an important role in mitigating both bloodborne and sexually transmitted HCV infections.

Despite its strengths, this study has some limitations. The survey-based design limits the ability to draw causal inferences and restricts the findings to associations. Self-reported data can also introduce bias, as participants may overestimate their awareness. Furthermore, the sample was skewed toward individuals from the Southwest zone and those with higher education, potentially underrepresenting less educated and rural populations. Future studies should strive for balanced demographic representation and use qualitative methods to gain deeper insights into barriers and facilitators of HCVST adoption. Including offline recruitment could help capture perspectives from more vulnerable and underrepresented groups.

In conclusion, this study reveals moderate awareness and support for HCVST among stakeholders in Nigeria. To realize the full potential of HCVST, program managers, implementing partners, and donors must address gaps in awareness and other practical challenges. Drawing on the lessons from HIVST, prioritizing education, expanding outreach, and ensuring effective linkage to care will help policymakers and practitioners integrate HCVST into Nigeria’s healthcare system. HCVST should become an integral part of national and subnational HCV elimination agenda by including it in public sector procurement mechanism and essential medicine list, mobilizing domestic financing from the public and private sectors. Such an approach will advance Nigeria’s progress toward eliminating HCV as a public health threat and improve overall health outcomes.