HCV Microelimination Strategies: An Interventional Study in Diagnosed Patients Without Access to the System

María Fernanda Guerra Veloz; Pilar Del Pino Bellido; Patricia Cordero Ruiz; Francisco Vega Rodriguez; Francisco Bellido Muñoz; Encarnación Ramirez de Arellano; Angel Caunedo Álvarez; Alvaro Pascual Hernandez; Isabel Carmona Soria


Liver International. 2021;41(5):928-933. 

In This Article

Abstract and Introduction


Hepatitis C virus (HCV) one-step diagnosis improves recovery in patients with active infection. However, patients with previous anti-HCV+ may be excluded. We aimed to identify and retrieve non-referred or lost-to-follow-up HCV-infected patients. All anti-HCV+ patients seen in our hospital between 2013 and 2018 were included. In the first phase, we identified anti-HCV+ patients who were not referred to the Gastroenterology Unit (GU) or lost-to-follow-up. In the second phase, recovered patients were invited for a one-step visit for liver evaluation. A total of 1330 anti-HCV+ patients were included: 21.7% had not been referred to GU, and 23.1% were lost-to-follow-up. In the second phase, 49.6% of patients were contacted, and 92.8% attended a medical consultation: 62.7% had active infection, 92.2% were treated, and 86.5% achieved SVR (ITT). We concluded that screening microbiological data and referring unidentified patients with active HCV infection directly to specialists is an effective tool in achieving HCV microelimination.


Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide, with 71 million people infected and an estimated global prevalence of 1.0%.[1] In Spain, anti-HCV prevalence is between 0.4% and 1.1% with 0.4% positive viremia.[2,3]

In the past five years, HCV treatment has improved significantly with the introduction of direct-acting antivirals (DAAs), achieving an effective cure in more than 90% of treated patients.[4] This sharp increase in the effectiveness of treatments has led the World Health Organization (WHO) to set the goal of eliminating HCV infection by 2030. To meet the WHO definition for elimination, 90% of HCV cases must be identified and 80% treated.[5] This goal can best be achieved through a microelimination approach, which entails pursuing elimination goals in defined populations.[6]

In Spain, more than 130,000 patients with chronic HCV have been treated since the introduction of the "Strategic Plan for addressing HCV in the National Health System" in 2015.[7] However, around 200,000 patients are estimated to have active HCV infection.[3,8,9]

To reduce diagnostic barriers, a one-step diagnosis was introduced in the National Health System (NHS) in 2018, by which viremia testing is conducted in the same blood sample in all patients who have a newly positive HCV antibody (anti-HCV+) test.[10] However, patients with anti-HCV+ before this strategy was implemented could remain undiagnosed if they were not referred to the gastroenterology specialists or if they failed to complete the diagnostic process.[11] We aimed to identify and retrieve potentially HCV-infected patients lost in the HCV care cascade in a Spanish NHS hospital and offer them HCV treatment.