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Impact of Hepatitis C Education on Hepatitis C Testing Uptake among Adults in Nigeria

Abstract

Hepatitis C virus infection is an important public health concern because it can cause chronic liver disease, cirrhosis, liver cancer, and other serious complications when it remains undiagnosed and untreated. Many individuals with hepatitis C may have no obvious symptoms during the early stages of infection, making testing important for identifying infected persons and facilitating timely linkage to appropriate healthcare and treatment. Hepatitis C education provides adults with information about hepatitis C infection, routes of transmission, risk factors, prevention strategies, misconceptions, availability of testing services, benefits of early diagnosis, and appropriate healthcare-seeking pathways. Hepatitis C testing uptake refers to participation in recommended hepatitis C testing among eligible adults through appropriate healthcare facilities, community testing programmes, or other approved testing services. In Nigeria, inadequate hepatitis C testing uptake may be associated with limited awareness, misconceptions about transmission, perceived low personal risk, stigma, fear of a positive result, financial barriers, limited access to testing facilities, and insufficient knowledge of the benefits of early diagnosis. Effective hepatitis C education may improve adults' knowledge and encourage greater utilization of available testing services. Against this background, this study investigates the impact of hepatitis C education on hepatitis C testing uptake among adults in Nigeria. The study is anchored on the Health Belief Model, Social Cognitive Theory, and the Knowledge-Attitude-Practice framework. The Health Belief Model provides a framework for understanding adults' decisions to undergo hepatitis C testing through perceived susceptibility to infection, perceived severity of possible complications, perceived benefits of early diagnosis, perceived barriers to testing, and cues to action. Social Cognitive Theory emphasizes the interaction between knowledge, self-efficacy, social influences, environmental conditions, and health-related behaviour in shaping testing practices. The Knowledge-Attitude-Practice framework provides a basis for examining how hepatitis C education may improve knowledge and attitudes and influence testing uptake. Collectively, these theoretical perspectives provide a suitable framework for explaining how hepatitis C education may influence hepatitis C testing uptake among adults in Nigeria. The study will adopt a quantitative quasi-experimental research design. Primary data will be collected from adults in selected communities, healthcare facilities, workplaces, and other appropriate settings in Nigeria using a structured interviewer-administered questionnaire, hepatitis C knowledge assessment, and hepatitis C testing uptake assessment tool. A multistage sampling technique will be employed to select states, local government areas, communities, households, healthcare facilities, and eligible adult participants. Where feasible, selected communities or participant groups will be assigned to intervention and comparison groups. Adults in the intervention group will receive structured hepatitis C education covering the nature of hepatitis C infection, routes of transmission, risk factors, prevention strategies, symptoms and asymptomatic infection, complications of untreated infection, availability and importance of testing, confidentiality of testing, and appropriate healthcare and referral pathways. Hepatitis C testing uptake will be assessed using indicators such as completion of hepatitis C testing following the education intervention, attendance at designated testing services, completion of recommended confirmatory testing where applicable, and linkage to appropriate healthcare following a positive test result. Where feasible, testing participation will be verified using testing records or service documentation rather than relying solely on self-report. Descriptive statistics will be used to summarize participants' sociodemographic characteristics, previous exposure to hepatitis education, hepatitis C knowledge, perceived risk, and testing history. Inferential statistical techniques, including chi-square tests, paired-sample tests, independent-sample tests, and logistic or multiple regression analysis, will be used to determine the impact of hepatitis C education on testing uptake. Where appropriate, testing uptake before and after the intervention will be compared. Diagnostic tests will also be conducted to assess the reliability of the research instruments, model assumptions, goodness of fit, and robustness of the findings. The study is expected to find that hepatitis C education has a significant positive impact on hepatitis C testing uptake among adults in Nigeria. Adults exposed to structured hepatitis C education are expected to demonstrate improved understanding of hepatitis C transmission, risk factors, prevention, possible complications, and the importance of early diagnosis. Increased awareness is expected to encourage eligible adults to seek hepatitis C testing and facilitate timely linkage to appropriate healthcare services when infection is detected. Education may also correct misconceptions about hepatitis C transmission and reduce fear and stigma associated with testing. However, education alone may not guarantee testing uptake because adults may continue to face barriers such as limited availability of testing services, cost of testing, geographical distance, transportation difficulties, fear of a positive diagnosis, stigma, confidentiality concerns, and limited awareness of where testing services are available. Consequently, hepatitis C education may be most effective when supported by affordable and accessible testing services, confidential testing environments, effective referral systems, community-based testing programmes, and sustained public health campaigns. The study is expected to contribute to the literature on hepatitis C education, hepatitis C testing, infectious disease prevention, liver health, health education, health-seeking behaviour, screening and testing practices, and public health in Nigeria by providing empirical evidence on the impact of hepatitis C education on testing uptake among adults. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, state ministries of health, hospitals, primary healthcare centres, infectious-disease programmes, public health practitioners, health educators, community health workers, development partners, and policymakers regarding strategies for improving early identification of hepatitis C infection. The study will also provide evidence-based recommendations for integrating hepatitis C education into community and primary healthcare programmes, expanding accessible testing services, strengthening referral and linkage-to-care systems, reducing misconceptions and stigma, improving public awareness of hepatitis C risk factors, and promoting timely hepatitis C testing among adults in Nigeria.

Keywords: Hepatitis C education, hepatitis C testing uptake, adults, Nigeria, hepatitis C virus, HCV testing, infectious disease prevention, liver health, health education, health-seeking behaviour, hepatitis C awareness, screening, early diagnosis, public health.