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Effect of Community-Based Hepatitis C Screening on Hepatitis C Detection among Adults in Nigeria

Abstract

Hepatitis C virus (HCV) infection is an important public health concern in Nigeria and may result in chronic liver disease, liver fibrosis, cirrhosis, hepatocellular carcinoma, and other serious complications when it remains undetected and untreated. Many individuals with HCV infection may remain asymptomatic for prolonged periods, making active screening important for identifying infections before significant liver damage develops. Community-based hepatitis C screening provides an opportunity to bring HCV testing closer to adults through community outreach programmes, primary healthcare centres, mobile health services, health campaigns, and other accessible community platforms. Early detection can facilitate confirmatory testing, clinical evaluation, linkage to antiviral treatment, and appropriate follow-up. However, limited awareness, inadequate screening coverage, financial constraints, geographical barriers, shortage of trained healthcare personnel, limited laboratory capacity, stigma, and weak referral and follow-up systems may restrict access to hepatitis C screening and subsequent care in Nigeria. Against this background, this study investigates the effect of community-based hepatitis C screening on hepatitis C detection among adults in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and the Health Systems Framework. The Health Belief Model explains how adults' perceptions of susceptibility to hepatitis C, perceived severity of infection, perceived benefits of screening, perceived barriers, and cues to action may influence participation in community-based hepatitis C screening. The Social Ecological Model emphasizes the influence of individual, interpersonal, household, community, socioeconomic, cultural, and healthcare factors on HCV-related risk, healthcare-seeking behaviour, screening participation, and access to treatment. The Health Systems Framework emphasizes service delivery, health workforce, health information, medical products and technologies, financing, laboratory capacity, and accessibility as essential components of effective community-based hepatitis C screening and linkage-to-care programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how community-based hepatitis C screening may influence hepatitis C detection among adults in Nigeria. The study will adopt a quantitative cross-sectional analytical or quasi-experimental research design. The study population will comprise adults aged 18 years and above residing in selected communities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, households, and eligible adults. Community-based hepatitis C screening will be measured using indicators such as availability of screening services, screening coverage, frequency of screening activities, HCV antibody testing, assessment of relevant risk factors, availability of trained healthcare personnel, testing materials, laboratory capacity, pre- and post-test counselling where applicable, health education, and referral arrangements. Hepatitis C detection will be assessed using indicators such as reactive HCV antibody screening results, newly identified individuals requiring confirmatory testing, confirmed active HCV infection where appropriate, viral testing following reactive screening, newly detected cases, referrals for clinical evaluation, linkage to antiviral treatment, and follow-up after diagnosis. Data will be collected using structured questionnaires, community screening registers, laboratory records, healthcare facility records, referral registers, and relevant community health programme documents. Descriptive statistics will be used to summarize participants' characteristics, HCV-related risk factors, screening coverage, test results, and patterns of hepatitis C detection. Inferential statistical techniques, including chi-square tests, correlation analysis, and logistic or multiple regression analysis, will be used to determine the effect of community-based hepatitis C screening on hepatitis C detection. Where appropriate, hepatitis C detection rates before and after implementation of community-based screening activities may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that community-based hepatitis C screening has a significant positive effect on hepatitis C detection among adults in Nigeria. Adults who participate in community-based hepatitis C screening are expected to have a higher likelihood of previously undetected HCV infection being identified than adults without access to such services. Community-based screening may facilitate early identification of individuals with reactive HCV antibody results and provide opportunities for appropriate confirmatory testing, clinical evaluation, and linkage to antiviral treatment. Bringing screening services closer to communities may reduce geographical, financial, and time-related barriers and reach adults who may not routinely seek healthcare or who may be unaware of their risk of HCV infection. Community health education may also improve awareness of HCV transmission, prevention, testing, treatment availability, and the importance of seeking medical evaluation. Early detection and linkage to appropriate treatment may reduce the risk of progression to chronic liver disease and other complications. Conversely, inadequate screening coverage, limited testing materials, shortage of trained personnel, financial barriers, stigma, insufficient laboratory capacity, and weak referral and follow-up systems may reduce the effectiveness of community-based hepatitis C screening. The study therefore expects accessible and well-organized community-based hepatitis C screening to contribute significantly to improved detection and early management of hepatitis C infection among adults in Nigeria. The study is expected to contribute to the literature on community-based hepatitis C screening, hepatitis C detection, viral hepatitis prevention, liver health, infectious disease screening, community health services, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, laboratory services, infectious disease specialists, hepatologists, community health workers, development partners, and policymakers regarding strategies for strengthening hepatitis C prevention and early detection. The study will also provide evidence-based recommendations for expanding community-based HCV screening programmes, improving access to reliable HCV testing, strengthening laboratory and confirmatory testing capacity, increasing public awareness, reducing stigma, improving healthcare worker training, strengthening referral and linkage-to-care systems, and integrating hepatitis C screening into appropriate community-based infectious disease and primary healthcare programmes across Nigeria.

Keywords: Community-based hepatitis C screening, hepatitis C detection, hepatitis C virus, HCV, adults, viral hepatitis, liver health, infectious disease screening, preventive healthcare, community health services, Nigeria, public health.