Optimizing Hepatitis C Virus Antibody Testing Strategy and Setting: Results From a Large Real-World Screening Program.

Background: Optimal hepatitis C virus (HCV) screening is required to prevent transmission and progression to advanced liver disease and to meet global elimination targets. While administrative health data can highlight trends in testing and treatment, additional information is required to understand barriers in the care cascade. We conducted a real-world analysis documenting the care cascade and the effectiveness of HCV antibody (Ab) screening modalities across different community and clinical settings. Methods: This was a cross-sectional study of individuals who completed HCV Ab testing at participating centers in Ontario, Canada, between May 2010 and June 2023. Results: Among 61 605 individuals tested, the prevalence of HCV Ab was 13.6% and highest among individuals aged 35-44 years (23.2%) and individuals tested at addiction clinics (41.0%). Among those with an HCV Ab-positive result, 79.7% ever completed RNA testing of whom 57.3% were RNA positive. Among those with an RNA-positive result, 65.0% attended a follow-up appointment. Among those who attended their appointment, 94.0% initiated treatment (61.1% of the RNA-positive), 77.4% of those who started had documented treatment completion (47.3% of the RNA-positive), and 59.6% of those who completed treatment had documented sustained virologic response 12 weeks after treatment (28.2% of the RNA-positive). The Ab testing modality was closely related to test setting, and primary care was the most effective at linkage to care. Conclusions: While there was some attrition from HCV Ab positivity to RNA testing, treatment initiation was higher compared with administrative data. These results highlight the benefits of multiple testing modalities and matching the optimal Ab testing modality to the setting, with strong pathways for linkage to care.