Awareness, linkage to care may motivate people with HCV to seek treatment

Nearly one in five hepatitis C virus (HCV) infections in the last decade have been treated with direct-acting antivirals (DAAs), as well as about a third of the target population, according to a study.

“However, 7 years remain to treat the remaining 70 percent of the target population,” the researchers said. “To accomplish this, expanded access, active HCV screening, and linkage to care may be required.”

This study used national HCV registries, reported DAA sales data, pharmaceutical companies’ reports, and estimates provided by national experts to estimate the number of people living with HCV (PLHCV) treated between 2014‒2023 across 119 countries. For countries without available data, the researchers used the average estimate of the corresponding Global Burden Disease region.

Estimates revealed a total of 13,816,000 (95 percent uncertainty intervals [UI], 13,221,000‒16,415,000) PLHCV received treatment. Of these, 12,748,000 (95 percent UI, 12,226,000‒15,231,000) were treated with DAAs, with 11,081,000 being sofosbuvir-based DAA regimens. Country-level data accounted for 97 percent of these numbers. [J Hepatol 2025;83:329-347]

High-income countries saw a 41-percent decline in treatment from its peak, with reimbursement as a significant predictor of treatment. On the other hand, low- and middle-income countries dealt with the important role of price in expanding access to treatment through public and private markets. Of note, treatment slowly rose following a sharp decline at the end of the national program in Egypt.

Care programs

Countries face difficulties in treating 80 percent of PLHCV, according to researchers. Studies suggest a third of diagnosed individuals are motivated to come in for treatment within the first 1‒3 years, one-third can be connected to care via awareness and linkage to care programs, while the last third will need more programs to be connected to care. [Liver Int 2020;40:1832-1840; Hepatology 2021;74:2974-2987]

“The low linkage to care in the general population may be explained by low awareness of HCV and its relation to liver cancer,” the researchers said.

In a survey conducted by World Hepatitis Alliance, only 42 percent of respondents were aware of an association between liver cancer and viral infection. A similar study in Brazil found only 23 percent of respondents attributed HCV infection to liver cancer. [Lancet Reg Health Am 2023;23:100531]

Likewise, a study in Uzbekistan reported 42 percent of PLHCV lost to follow-up were not aware of the risk of liver cancer associated with their infection. [Liver Int 2023;43:773-784]

“Although screening for HCV is important to meet the WHO elimination targets, awareness programs will be needed to motivate PLHCV to seek treatment,” the researchers said. “In addition, linkage to care programs will be needed to bring in those who are less motivated to seek care.”

Recent studies suggest the possibility of bringing back >30 percent of PLHCV lost to follow-up into care through active linkage to care initiatives. [BMC Gastroenterol 2023;23:40; Infect Dis (Lond) 2023;55:361-369]

“Regional and temporal variations highlight the importance of active screening strategies,” the researchers said. “Without program enhancements, the number of treated PLHCV stalled in every country/region, which may not reflect a lower prevalence but may instead reflect the diminishing returns of existing strategies.”