{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T10:41:31Z","timestamp":1780656091666,"version":"3.54.1"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T00:00:00Z","timestamp":1763337600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003107","name":"Bundesministerium f\u00fcr Gesundheit","doi-asserted-by":"publisher","award":["GHPP"],"award-info":[{"award-number":["GHPP"]}],"id":[{"id":"10.13039\/501100003107","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Kyrgyz programme on the elimination of HIV and ending AIDS and viral hepatitis infections (2023\u20132027) recognizes the need to scale up testing and include primary healthcare. Our aim was to identify and analyse important barriers and facilitators to HIV and hepatitis B, C and D testing from the perspective of medical doctors working in primary healthcare in the Kyrgyz Republic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional, mixed-methods study in the Kyrgyz Republic from June to November 2024, and first conducted in-depth semi-structured interviews. We applied a thematic analysis for qualitative analysis. We developed a questionnaire based on these main themes, which was distributed to medical doctors working in primary healthcare. A descriptive analysis of the questionnaire data followed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Through 21 interviews, we identified training gaps, lack of knowledge, lack of time and physical space as well as social and cultural perceptions as key barriers. Data from 1,080 questionnaire responses (89% female; 46% 61 years or older) supported this with 35% reporting lack of time, 39% lack of doctors, and over 60% indicating need for further training.<\/jats:p>\n                    <jats:p>Identified facilitators included knowledge of guidelines, new technologies, e.g., self-testing, and the possibility of linking testing to hepatitis B vaccination. Questionnaire data confirmed access to free testing and treatment (HIV: 86%, viral hepatitis 89%), knowledge of testing indications (HIV: 80%, viral hepatitis: 76%), and linkage to vaccination (71%) as important facilitators. Lack of experience with key populations was evident with 78% not identifying any members of key populations as patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>To increase testing and reach the goals of ending AIDS and the epidemics of viral hepatitis, doctors in primary healthcare need capacity-building in the form of HIV and viral hepatitis training and knowledge dissemination to offer testing. Moreover, the availability and distribution of doctors in primary healthcare need to be prioritized and enhanced in areas in most need of care to ensure access to testing for all in the Kyrgyz Republic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0336257","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T18:33:01Z","timestamp":1763404381000},"page":"e0336257","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Barriers and facilitators to HIV and viral hepatitis testing in primary healthcare settings in the Kyrgyz Republic: A mixed-methods study using the COM-B Framework"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5672-8250","authenticated-orcid":true,"given":"Ida","family":"Sperle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8567-9240","authenticated-orcid":true,"given":"Nikolay","family":"Lunchenkov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastassiya","family":"Stepanovich-Falke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuridin S.","family":"Nurmatov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aybek A.","family":"Bekbolotov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisuluu","family":"Bolotbaeva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aman","family":"Taalaibekov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2645-863X","authenticated-orcid":true,"given":"Zamira","family":"Abdrakhmanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2785-9811","authenticated-orcid":true,"given":"Zulpueva Akmaral","family":"Aidarbekovna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2820-5019","authenticated-orcid":true,"given":"Michael","family":"Brandl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olena","family":"Kysil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stela","family":"Bivol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviane","family":"Bremer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Gunsenheimer-Bartmeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Dudareva","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,11,17]]},"reference":[{"key":"pone.0336257.ref001","volume-title":"Global hepatitis report 2024: action for access in low- and middle-income countries","author":"World Health Organization","year":"2024"},{"key":"pone.0336257.ref002","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.ijid.2020.12.068","article-title":"Prevalence of HIV, HCV and HBV in Central Asia and the Caucasus: A systematic review","volume":"104","author":"S Davlidova","year":"2021","journal-title":"Int J Infect Dis"},{"key":"pone.0336257.ref003","volume-title":"The urgency of now: AIDS at a crossroads","author":"UNAIDS","year":"2024"},{"key":"pone.0336257.ref004","volume-title":"Regional action plans for ending AIDS and the epidemics of viral hepatitis and sexually transmitted infections 2022\u20132030","author":"World Health Organization","year":"2023"},{"issue":"10","key":"pone.0336257.ref005","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/S2468-1253(23)00197-8","article-title":"Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study","volume":"8","author":"Polaris Observatory Collaborators","year":"2023","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"pone.0336257.ref006","author":"Coalition for Global Hepatitis Elimination"},{"key":"pone.0336257.ref007","author":"UNAIDS","year":"2023"},{"key":"pone.0336257.ref008","volume-title":"Health Systems in Action: Kyrgyzstan","author":"World Health Organization","year":"2021"},{"key":"pone.0336257.ref009","volume-title":"Can people afford to pay for health care? New evidence on financial protection in Kyrgyzstan","author":"M Jakab","year":"2018"},{"key":"pone.0336257.ref010","volume-title":"HIV and Viral Hepatitis Programme Review in Kyrgyzstan","author":"World Health Organization","year":"2022"},{"issue":"3","key":"pone.0336257.ref011","first-page":"1","article-title":"Kyrgyzstan: Health System Review","volume":"24","author":"S Moldoisaeva","year":"2022","journal-title":"Health Syst Transit"},{"issue":"1","key":"pone.0336257.ref012","article-title":"Results of Testing for Viral Hepatitis B and C in the Kyrgyz Republic, 2008 -2021","volume":"7","author":"STAJT Tobokalova","year":"2023","journal-title":"Acta Scientific Medical Sciences"},{"key":"pone.0336257.ref013","author":"World Health Organization"},{"issue":"4","key":"pone.0336257.ref014","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1177\/09564624231219285","article-title":"Universal-offer HIV testing in primary care: A mixed-methods evaluation of a pilot study","volume":"35","author":"R Wenlock","year":"2024","journal-title":"Int J STD AIDS"},{"issue":"12","key":"pone.0336257.ref015","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1111\/jvh.13182","article-title":"Hepatitis B and C testing strategies in healthcare and community settings in the EU\/EEA: A systematic review","volume":"26","author":"LMK Mason","year":"2019","journal-title":"J Viral Hepat"},{"issue":"9","key":"pone.0336257.ref016","doi-asserted-by":"crossref","first-page":"101122","DOI":"10.1016\/j.jhepr.2024.101122","article-title":"Successful hepatitis B and C screening in the health check-up in the German primary care setting","volume":"6","author":"O B\u00e4tz","year":"2024","journal-title":"JHEP Rep"},{"issue":"6","key":"pone.0336257.ref017","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1093\/fampra\/cmy032","article-title":"Improving the hepatitis cascade: assessing hepatitis testing and its management in primary health care in China","volume":"35","author":"WCW Wong","year":"2018","journal-title":"Fam Pract"},{"key":"pone.0336257.ref018","volume-title":"Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations","author":"World Health Organization","year":"2022"},{"key":"pone.0336257.ref019","doi-asserted-by":"crossref","DOI":"10.2196\/62929","article-title":"Barriers and Facilitators to HIV and Viral Hepatitis Testing in Primary Health Care Settings in the Kyrgyz Republic (BarTest): Protocol for a Mixed Methods Study","volume":"14","author":"I Sperle","year":"2025","journal-title":"JMIR Res Protoc"},{"issue":"6","key":"pone.0336257.ref020","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"pone.0336257.ref021","doi-asserted-by":"crossref","DOI":"10.4135\/9781446288030","volume-title":"The Problem-Centred Interview: Principles and Practice","author":"A Witzel","year":"2012"},{"key":"pone.0336257.ref022","doi-asserted-by":"crossref","first-page":"17","DOI":"10.4135\/9781526405555.n2","article-title":"Thematic analysis","volume-title":"The SAGE handbook of qualitative research in psychology","author":"G Terry","year":"2017"},{"key":"pone.0336257.ref023","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.drugalcdep.2017.07.002","article-title":"Uptake of needle and syringe program services in the Kyrgyz Republic: Key barriers and facilitators","volume":"179","author":"A Deryabina","year":"2017","journal-title":"Drug Alcohol Depend"},{"issue":"9","key":"pone.0336257.ref024","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1089\/apc.2015.0083","article-title":"Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China","volume":"29","author":"Y Liu","year":"2015","journal-title":"AIDS Patient Care STDS"},{"issue":"1","key":"pone.0336257.ref025","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1186\/s12889-024-18953-5","article-title":"Barriers and facilitators to viral hepatitis testing in Uzbekistan: scoping qualitative study among key stakeholders, healthcare workers, and the general population","volume":"24","author":"A Mazhnaya","year":"2024","journal-title":"BMC Public Health"},{"key":"pone.0336257.ref026","volume-title":"HIV stigma in the healthcare setting","author":"European Centre for Disease Prevention and Control","year":"2024"},{"issue":"2","key":"pone.0336257.ref027","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative Research in Psychology"},{"key":"pone.0336257.ref028","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/1748-5908-6-42","article-title":"The behaviour change wheel: a new method for characterising and designing behaviour change interventions","volume":"6","author":"S Michie","year":"2011","journal-title":"Implement Sci"},{"key":"pone.0336257.ref029","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1186\/s12879-015-1104-8","article-title":"Identification of hepatitis B and C screening and patient management guidelines and availability of training for chronic viral hepatitis among health professionals in six European countries: results of a semi-quantitative survey","volume":"15","author":"A Bechini","year":"2015","journal-title":"BMC Infect Dis"},{"issue":"1","key":"pone.0336257.ref030","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1186\/s12875-023-02161-y","article-title":"Understanding the effect of an educational intervention to optimize HIV testing strategies in primary care in Amsterdam - results of a mixed-methods study","volume":"24","author":"S Bogers","year":"2023","journal-title":"BMC Prim Care"},{"issue":"4","key":"pone.0336257.ref031","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1093\/eurpub\/ckp231","article-title":"Barriers to HIV testing in Europe: a systematic review","volume":"20","author":"J Deblonde","year":"2010","journal-title":"Eur J Public Health"},{"issue":"5","key":"pone.0336257.ref032","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s11904-022-00614-0","article-title":"HIV Testing Uptake According to Opt-In, Opt-Out or Risk-Based Testing Approaches: a Systematic Review and Meta-Analysis","volume":"19","author":"QR Soh","year":"2022","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"619","key":"pone.0336257.ref033","doi-asserted-by":"crossref","DOI":"10.3399\/bjgp14X677103","article-title":"Public attitudes towards opt-out testing for HIV in primary care: a qualitative study","volume":"64","author":"S Glew","year":"2014","journal-title":"Br J Gen Pract"},{"issue":"1","key":"pone.0336257.ref034","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0052845","article-title":"Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study)","volume":"8","author":"AK Sullivan","year":"2013","journal-title":"PLoS One"},{"key":"pone.0336257.ref035","volume-title":"Public health guidance on HIV, hepatitis B and C testing in the EU\/EEA \u2013 An integrated approach","year":"2018"},{"issue":"5","key":"pone.0336257.ref036","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1177\/0956462416652274","article-title":"General practitioners\u2019 barriers and facilitators towards new provider-initiated HIV testing strategies: a qualitative study","volume":"28","author":"IK Joore","year":"2017","journal-title":"Int J STD AIDS"},{"key":"pone.0336257.ref037","author":"ILGA-Europe","year":"2023"},{"key":"pone.0336257.ref038","volume-title":"Stigma: survey of people living with HIV","author":"European Centre for Disease Prevention and Control","year":"2023"},{"key":"pone.0336257.ref039","volume-title":"Ensuring quality health care by reducing HIV-related stigma and discrimination: technical brief","author":"World Health Organization","year":"2024"},{"key":"pone.0336257.ref040","volume-title":"People Living with HIV Stigma Index 2.0 Kyrgyz Republic","author":"Harm Reduction Network Association","year":"2022"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336257","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T18:33:09Z","timestamp":1763404389000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0336257"}},"subtitle":[],"editor":[{"given":"Jason T.","family":"Blackard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,11,17]]},"references-count":40,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0336257","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,17]]}}}