Discussion
MSM
Our randomized controlled trial found that providing HCV self-testing among MSM substantially increased HCV test uptake compared with the standard of care. Our data suggested minimal harm associated with HCV self-testing. This study expands the literature by including people at higher risk and lower risk for HCV, leveraging digital methods for community engagement and implementation, using an RCT, and examining the cost of HCV self-testing. Findings from this study provide evidence to support the implementation and scale-up of HCV self-testing programmes among MSM.Our results showed that HCV self-testing increases HCV testing uptake among MSM living with HIV. Numerous studies have demonstrated that MSM living with HIV have a higher HCV prevalence compared to individuals who do not have HIV [Our study also showed that HCV self-testing increases HCV testing uptake among a lower risk group. This finding is consistent with several studies on self-testing for HIV [Additionally, over half (58.6%) of HCV self-testers reported that the self-test was their first ever HCV test. This indicates that HCV self-testing has the potential to reach those who may not otherwise test. This is particularly important during the COVID-19 pandemic when facility-based testing is diminished or non-existent. Together with high acceptability and rare occurrence of social harms associated with HCV self-testing, which is consistent with data from the WHO guidelines on HCV self-testing and extensive HCV self-testing implementation research [We found that HCV self-testing is cheaper per person tested compared to facility-based testing. The cost of testing has been identified as an important barrier to HCV testing [Our study has several limitations. First, COVID-19 regulations restricting access to facility-based testing in China might have increased demand for decentralized testing. However, during this study, the mean number of reported COVID-19 cases in the seven study sites was two people. There were no severe lockdowns during this period in the study sites and HCV services were likely near normal [