Hepatitis C virus screening in Piemonte: an effective strategy to eliminate HCV chronic infections

Abstract

Abstract In 2016, WHO set the goal of elimination of Hepatitis C Virus (HCV) by 2030. Globally, about 58 million people have chronic HCV, which causes cirrhosis, hepatocellular carcinoma and death (around 300000 in 2019), representing a heavy burden for public health. In Italy, the incidence of HCV acute infection is around 0.11 per 100000, and the estimated number of non-diagnosed chronic infections is 280000. In order to reach WHO's goal, the Istituto Superiore di Sanità (ISS) and the Ministry of Health implemented a strategy based on the detection of silent chronic infections and their treatment with direct-acting antivirals (DAAs), which cure around 95% of HCV infections. Therefore, in 2022, Regione Piemonte started a screening program contacting all residents born between 1969 and 1989. The screening was performed with rapid blood tests (antibodies detection, sensibility and specificity ca. 99%), and in case of a positive result, a HCV-RNA test was offered to confirm chronic infection and the need for treatment with DAAs. The Local Health Authority TO3, invited 36120 out of 158017 eligible residents (temporary and permanent), in the period March 2022 - April 2023 with invitation letters or catch-up strategies on other occasions; 6000 rapid blood tests were used (16.6% of invited population), and 11 (0.19%) tested positive. The RNA test confirmed 5 (0.08%) results. All the positive subjects were referred to 2 hospitals for DAAs treatment. As demonstrated by ISS, HCV screening could represent an effective mean to meet WHO's goal of HCV elimination by 2030 and also allow us to reduce HCV's burden on public health; although, with the current low adhesion rate, these results may not be reachable. Therefore, it is necessary to implement health promotion campaigns, to involve more stakeholders, including social and healthcare associations, General Practitioners and policy-makers, as the entire population's health would benefit from a successful HCV elimination program. Key messages • HCV and viral hepatitis represent a heavy burden for public health, high costs for Health Systems and severely affect the quality of life of subjects with un-diagnosed chronic infections. • The availability of reliable, non-invasive, tests and of extremely effective treatments should move policy-makers to allocate more resources in the implementation of HCV eradication strategies.