Introduction Currently, only a small number of methadone users are tested for hepatitis C virus (HCV) even though the greatest risk of acquiring the virus is through injecting drug use. To improve the uptake it is crucial to understand patients’ preferences for testing so that the service can be redesigned to optimise uptake. Testing can be performed by a number of providers including drug workers and GPs. More recently, Dried Blood Spot testing (DBST) can also be performed within pharmacies. The daily contact with patients, through collection of opioid replacement therapy (ORT), may increase testing rates. However, little is known about whether ORT users would prefer to have their testing at the pharmacy. This study used a survey technique called Discrete Choice Experiments (DCE) to elicit ORT users’ preference for HCV testing. DCEs provide information on the relative importance of testing attributes such as type of provider and waiting time. This study also investigated whether the use of incentives may help improve uptake of testing and if so by how much.
Method Attributes of DBST were identified through the literature and by means of a focus group series with OST users. The attributes were: provider (pharmacy (own and other), drug worker, GP); whether treated with dignity and respect; travel distance; waiting time for results; and incentive payment. Participants were asked to choose between two different tests which varied in terms of the attributes, or a “no test” option. There were 16 choices in total. Conditional logit analysis using STATA was used to estimate the relative importance of each of the attributes. The sample consisted of 77 ORT users in Tayside.
Results The results showed that ORT users preferred to be tested at their own pharmacy, followed by drug worker, GP and other pharmacy. The most important attribute was whether they were treated with dignity and respect. On average, incentives were not important to ORT users. However, there was heterogeneity within the sample with a sub-group preferring to receive incentives. Very few respondents opted out (chose no test). This is surprising given the current low uptake. This may suggest presence of hypothetical bias (respondents not doing in real life what they say they would do in the DCE) and/or may reflect that they are not routinely offered testing.
Conclusion To increase uptake testing should be provided within pharmacies whilst ensuring that ORT users are treated with dignity and respect. The use of incentives may improve uptake rates in a sub sample of OST users only. The preference for pharmacy provision of HCV testing may suggest that a full pharmacy pathway, which includes treatment also, has the potential to optimise HCV outcomes.
Disclosure of interest None Declared.