POLICY BRIEF

Achieving Hepatitis C Virus Elimination
Aligned with SDG 3.3 and WHO Targets

Hepatitis C virus (HCV) is a major global health challenge, affecting over 58 million people and causing 290,000 deaths annually due to complications such as liver cirrhosis and hepatocellular carcinoma. Recognizing its preventable and curable nature, the World Health Organization (WHO) has set ambitious targets to eliminate HCV as a public health threat by 2030. This effort aligns with Sustainable Development Goal (SDG) 3.3, which aims to combat viral hepatitis and other communicable diseases. The WHO’s HCV elimination goals include reducing new infections by 80%, diagnosing 90% of those infected, and treating 80% of eligible patients. Achieving these targets requires a comprehensive, multi-pronged approach encompassing prevention, screening, treatment, and public awareness. This Fast-Track Health policy note highlights best practices through five case studies, highlights challenges and opportunities, and provides actionable recommendations for municipal, national, and regional health authorities.

National HCV Elimination in Egypt: Egypt has become a global model for HCV elimination through its “100 Million Healthy Lives” campaign. Launched in 2018, the program provided free mass screening and treatment for HCV, leveraging a nationwide network of mobile clinics and health centers. Partnerships with pharmaceutical companies enabled Egypt to procure direct-acting antivirals (DAAs) at significantly reduced costs. By 2021, Egypt had screened over 60 million people and treated more than 4 million, reducing HCV prevalence from 14% to less than 2%. (Lancet Gastroenterology & Hepatology, 2022)

HCV Micro-Elimination in Iceland: Iceland adopted a micro-elimination approach, targeting high-risk populations such as people who inject drugs (PWID). The “Treatment as Prevention for Hepatitis C” (TraP Hep C) program focused on testing, linkage to care, and immediate treatment for PWID through harm reduction services. By integrating HCV care into existing needle exchange programs and providing DAAs at no cost, Iceland achieved a 90% reduction in new HCV infections among PWID within five years. (Journal of Hepatology, 2022)

HCV Testing and Treatment in Mongolia: Mongolia implemented a nationwide HCV screening program in 2016, targeting adults aged 15-64. Community health workers were trained to provide free point-of-care rapid tests, with positive cases referred to regional hospitals for confirmatory testing and treatment. Subsidized access to DAAs ensured affordability, leading to high treatment completion rates. By 2022, Mongolia had screened over 1.5 million people, achieving a 70% treatment rate among diagnosed cases. (Hepatology International, 2023)

Innovative Financing for HCV Treatment in Georgia: Georgia launched its Hepatitis C Elimination Program in 2015 with significant support from international partners, including the WHO and Gilead Sciences. The program introduced a co-financing mechanism, where the government covered operational costs while DAAs were donated. Georgia integrated HCV testing into primary healthcare and prison health services, ensuring high coverage among high-risk populations. By 2022, the program had treated over 80% of diagnosed cases, making Georgia one of the few countries on track to meet WHO targets. (WHO, 2023)

Digital Health for HCV Elimination in Australia: Australia has leveraged digital health tools to enhance HCV care, particularly in remote and underserved areas. Telehealth services enable specialist consultations for patients in rural regions, reducing geographic barriers to care. The government also implemented a digital registry to monitor treatment outcomes and track progress toward elimination goals. This approach has significantly improved linkage to care, with over 70% of diagnosed individuals initiating treatment. (Hepatology, 2023)

Achieving HCV elimination is hindered by several challenges. Despite the availability of DAAs, the high cost of these treatments remains a barrier in many countries. Screening rates are suboptimal, partly due to limited awareness and stigma surrounding HCV, which discourages high-risk populations, such as people who inject drugs (PWID), men who have sex with men (MSM), and incarcerated individuals, from seeking testing and care. Needle exchange programs (NEPs) and opioid substitution therapy (OST), which are proven to reduce HCV transmission among PWID, remain underfunded and poorly implemented. Weak healthcare infrastructure and workforce shortages impede timely diagnosis, linkage to care, and treatment in resource-constrained settings. Additionally, fragmented data systems make it difficult to track progress, identify gaps, and evaluate the effectiveness of interventions. Political and societal resistance to harm reduction programs like NEPs and OST exacerbates these challenges, limiting the reach of essential services to populations most at risk.

Despite these challenges, significant opportunities exist to accelerate HCV elimination, particularly by scaling up harm reduction services. Expanding needle exchange programs and opioid substitution therapy can dramatically reduce HCV transmission rates among PWID, a key population driving the epidemic in many regions. The availability of generic DAAs offers an opportunity to negotiate lower prices and expand access to curative treatment, making elimination goals more attainable. Integrating HCV testing into routine health services, such as HIV programs and antenatal care, can enhance case detection and improve linkage to care. Digital health innovations, including telemedicine and electronic health registries, can streamline service delivery and enable better tracking of outcomes. Community-based approaches, such as mobile clinics and outreach programs, can bring services directly to underserved populations, addressing access and stigma-related barriers. Finally, fostering regional and global partnerships can amplify the impact of harm reduction efforts, ensuring that NEPs, OST, and other targeted interventions are prioritized and scaled to meet the needs of the most vulnerable groups.