LITERATURE UPDATE
Lessons Learned from Global Hepatitis C Elimination Programs Handanagic S, Shadaker S, Drobeniuc J et al. J Infect Dis. 2024 May 8; 229 (Supplement_3): S334–S341. doi: 10.1093/infdis/jiad198.
In 2016, the World Health Organization introduced global targets for the care and management of hepatitis C virus (HCV) infection to eliminate hepatitis C as a public health threat by 2030. Despite significant improvements in testing and treatment, in 2020 only 23% of all persons infected with HCV globally were diagnosed. In this study the authors explore examples from global hepatitis C programmes in Georgia, Rwanda, and Nigeria that have used decentralised and integrated models to increase access to HCV testing. Georgia established the world’s
first national hepatitis C elimination programme in 2015. In 2022, 2.6 million people (80% of the adults) have been screened for antibodies for HCV infection, and 80,000 persons with HCV RNA detected were treated. To achieve these results, Georgia implemented HCV core antigen testing, utilisation of point-of-care (POC) HCV RNA testing, and simplification of HCV viraemia detection by qualitative HCV RNA testing. Rwanda was the first country in
sub-Saharan Africa to commit to HCV elimination in 2018, and as of 2022 it has achieved its screening target of 7 million people and initiated approximately 60,000 patients on hepatitis C treatment by rapid decentralisation and integration of HCV services.
In Nigeria, the integrated near-POC
testing approach in Nasarawa State has been effective in expanding access to HCV viraemia testing and enabling the possibility of same-day testing and treatment initiation. Examples of decentralisation and
integration of HCV testing and linkage to care in Georgia, Rwanda, and Nigeria could help inform effective strategies to reach 2030 hepatitis C elimination goals in other countries.
Self-testing strategy to eliminate hepatitis C as per World Health Organization’s goal: Analysis of disease burden and cost- effectiveness
Shin G, Kim BK, Bae S, Lee H, Ahn SH. Clin Mol Hepatol. 2025 Jan; 31 (1): 166–178. doi: 10.3350/cmh.2024.0484.
The World Health Organization (WHO) aims to eliminate hepatitis C virus (HCV) by 2030; therefore, widespread HCV screening is required. The WHO recommends HCV self-testing (HCVST) as a new approach. Here, the authors aimed
Testing for hepatitis C is important because the virus can cause liver damage, cirrhosis and hepatocellular carcinoma.
to evaluate disease burden reduction using the HCVST screening strategy and identify the most cost-effective approach. The authors developed a dynamic
open-cohort Markov model to assess the long-term effects and cost-effectiveness of HCVST in the Republic of Korea from 2024 to 2030. Strategies for comparison included universal, birth cohort, high- risk group screening, and no screening, focusing on the following: 1) incremental cost-effectiveness ratio (ICER) per disability-adjusted life-year (DALY) saved; 2) severe liver disease cases; and 3) liver- related death reduction. Universal HCVST screening is the most
effective strategy for achieving the WHO goal by 2030, substantially lowering the incidence of severe liver disease by 71% and preventing liver-related deaths by 69%, thereby averting 267,942 DALYs. Moreover, with an ICER of US$ 8,078 per DALY and high cost-effectiveness, the sensitivity results prove that cost- effectiveness is robust. Although high- risk group screening offers the lowest cost compared with other strategies, its effectiveness in preventing severe liver disease is minimal, falling short of the current WHO goal. This study confirms that universal
HCVST screening is a cost-effective strategy aligned with the WHO goal to eliminate HCV by 2030. Despite its higher costs compared to risk-based screening, the disease burden can be significantly reduced by providing effective HCVST access to individuals who might otherwise not be tested.
Comparison of a hepatitis C core antigen assay to nucleic acid amplification testing for detection of hepatitis C viremia in a US population Gunsolus IL, Prostko J, Pearce S et al. Microbiol Spectr. 2024 Nov 5; 12 (11): e0097524. doi: 10.1128/spectrum.00975-24. The prevalence of hepatitis C virus
(HCV) infection in the United States has increased over the past decade despite the development of effective direct- acting antiviral treatments. To meet the World Health Organization (WHO) goal of eliminating HCV infection by 2030, transmission events must be reduced. Currently, infection screening relies
on detection of HCV antibodies, with nucleic acid amplification testing (NAAT) used to confirm HCV viraemia and monitor changes in viral load. However, the seroconversion window for detection of HCV antibodies is long, averaging six weeks, with delayed seroconversion common in co-infected and immunosuppressed populations. Testing for HCV core antigen, which is present approximately five weeks before HCV antibodies, holds promise for earlier detection of HCV infection. It may also hold promise as a cheaper, more accessible, and more rapid alternative to NAAT for infection confirmation. Here, the authors evaluated the
agreement between a research-use HCV Core Antigen Assay and NAAT among US patients receiving clinically indicated NAAT. Among 412 specimens, the overall concordance was 97.1%, with a positive percent agreement of 95.5%. Discrepancies primarily occurred among patients with chronic HCV and low viral loads; 11/12 discrepancies showed viral loads <4,000 IU/mL.
Among patients being screened
for HCV infection (ie excluding those undergoing NAAT for serial monitoring of a previously diagnosed infection), the positive percent agreement was 97.0%. Among patients undergoing serial testing, changes in HCV Core Antigen Assay signal-to-cut-off values were generally correlated with changes in the viral load. Results suggest that the research-use HCV Core Antigen Assay studied here may reliably detect and/or confirm HCV infection.
September 2026
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