Data on the acceptability and usability of hepatitis C virus self-testing (HCVST) remain scarce. We estimated the pooled rates of acceptability/feasibility and re-reading/re testing agreement of HCVST using oral fluid tests (PROSPERO-CRD42022349874). We searched online databases for studies that evaluated acceptability, usability and inter-reader/operator variability for HCVST using oral fluid tests. Pooled estimates of feasibility, agreement and post-testing perspectives were analysed. Sensitivity analyses were performed in men who have sex with men (MSM) and people who inject drugs (PWID). Heterogeneity was assessed using the I2 statistics. A total of six studies comprising 870 participants were identified: USA (n= 95 with liver disease), Kenya (n= 150 PWID), Egypt (n= 116 from the general population), Vietnam (n= 104 MSM and n= 105 PWID), China (n= 100 MSM) and Georgia (n= 100 MSM and n= 100 PWID)]. All studies used OraQuick® HCV Rapid Antibody Test. The pooled overall es timates for correct sample collection and for people who performed HCVST without needing assistance in any step (95% confidence interval [CI]) were 87.2% [76.0–95.3] (n= 755; I2= 93.7%) and 62.6% [37.2–84.8] (n= 755; I2= 98.0%), respectively. The pooled estimate of agreement for re-reading was 95.0% [95% CI 91.5–97.6] (n= 831; I2= 74.0%) and for re-testing was 94.4% [90.3–97.5] (n= 726; I2= 77.1%). The pooled estimate of those who would recommend HCVST was 94.4% [84.7–99.6] (n= 625; I2= 93.7%). Pooled estimates (95% CI) of correct sample collection (72.8% [63.3–81.5] vs. 90.8% [85.9–94.8]) and performance of HCVST without needing assistance (44.1% [14.1–76.7] vs. 78.1% [53.4–95.3]) was lower in PWID compared to MSM. In summary, HCV testing with oral fluid HCVST was feasible and well-accepted. Oral fluid HCVST should be considered in key populations for uptake HCV testing.