Evaluation of the National Viral Hepatitis Control Program in Uttarakhand: A mixed-method approach.

Introduction: Conforming to the global commitment of combating viral hepatitis by 2030, India launched the National Viral Hepatitis Control Program (NVHCP) in 2018. NVHCP is a comprehensive strategy that uses a cascade of care approach to tackle all forms of viral hepatitis. This study was conceptualized to assess the implementation status of NVHCP and to understand the key stakeholders' perspective on prevention, screening, diagnosis, and treatment of viral hepatitis in Uttarakhand. Material and Methods: The study commenced in July 2021 and was conducted over a year in six districts of Uttarakhand. The program was evaluated using a sequential explanatory mixed-method approach with a pragmatic stance, incorporating a quantitative component of record-based analysis and a qualitative component of key informant interviews (KIIs) with program managers, physicians, and laboratory technicians. Results: NVHCP integrated effectively with the preexisting healthcare infrastructure and programs to provide primary and secondary levels of prevention. The program picked up pace initially by identifying the service delivery points, training the nominated personnel, and supplying logistics for screening and treatment. However, the developments were halted by the COVID-19 pandemic, which ensued shortly after the first NVHCP budget allocation. From 2019-20 to 2020-21, the pandemic resulted in a 73% decline in hepatitis B virus (HBV) screening and a 76% decline in hepatitis C virus (HCV) screening. The biggest missing link in the cascade of care for HCV was the nonavailability of PCR-based diagnostic viral load testing at treatment centers. A lack of a dedicated data management portal, an inefficient supply chain, and a lack of nomination of pharmacists and peer support were some of the gaps that could be addressed to accelerate the elimination process.