ArticleThe Lancet regional health. Western Pacific2025
Early performance of a decentralised, primary-care hepatitis C programme in Cambodia: a retrospective programme evaluation, 2024.
Article in The Lancet regional health. Western Pacific, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Real-world evidence on decentralised, primary-care delivery for hepatitis C virus (HCV) in the Western Pacific is limited. We evaluated Cambodia's national, primary care-led HCV programme in 2024. Methods: We analysed facility-level data from 256 health facilities in 15 operational districts to assess six HCV cascade steps: screening, anti-HCV positivity, RNA testing, viraemia, treatment initiation, and treatment completion. Design-based survey estimators were used to estimate proportions with 95% confidence intervals (CIs). To account for multi-stage design (clustering within operational districts), design-based generalised linear models were utilised to assess the factors associated with viraemia, treatment initiation and completion. Findings: HCV testing coverage among adults (≥18 years; denominator 2,196,351) was 3·5% (95% CI 2·5-4·4). Of 76,512 adults tested, 3213 (4·2%; 95% CI 3·1-5·6) were anti-HCV-positive; 2628/3213 (81·8%) received RNA testing, and 1446/2628 (55·0%; 95% CI 49·5-60·3) were viraemic (1·9% of all tested). Among RNA-positive individuals, 1345/1446 (93·0%) initiated direct-acting antivirals and 1289/1345 (95·8%) completed treatment. Viraemia was higher among men (adjusted odds ratio [aOR] 1·40; 95% CI 1·05-1·86), varied by province (Takeo aOR 2·79, Kampong Cham aOR 2·11 versus Battambang), and elevated in October-December (Q4; aOR 1·79) versus January-March. Treatment initiation and completion surpassed 90% across facilities. The principal gap was confirmatory testing (18·2% of anti-HCV-positive individuals lacked RNA testing). Interpretation: A decentralised, primary-care model achieved high linkage and treatment completion in the first year. Closing the confirmatory testing gap (reflex RNA/core antigen from same encounter), prioritising low-coverage/high-burden districts, and establishing patient-level linkage to capture sustained virologic response at week 12 are priorities to accelerate elimination. Funding: ANRS MIE (ANRS0689b).
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