Feasibility, effectiveness and cost of a decentralized HCV care model among the general population in Delhi, India.

Abstract

Background and aimsIndia has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale‐up in testing and treatment. The “HEAD‐Start Project Delhi” aimed to enhance HCV diagnosis and treatment pathways among the general population.MethodsA prospective study was conducted at 5 district hospitals (Arm 1: one‐stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment) and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn‐around time were measured.ResultsBetween January and September 2019, 37 425 participants were screened for HCV. The median (IQR) age of participants was 35 (26‐48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P < .001). Of those confirmed positive, treatment was initiated at significantly higher rates for participants in both Arms 1 (85.6%) and 2 (73.7%) compared to Arm 3 (41.8%, P < .001). Arm 1 was found to be a cost‐saving strategy compared to Arm 2, Arm 3, and no action.ConclusionsDelivery of all services at a single site (district hospitals) resulted in a higher yield of HCV seropositive cases and retention compared with sites where participants were referred elsewhere for VL testing and/or treatment. The highest level of retention in the care cascade was also associated with the shortest turn‐around times.