HCV Cure: To Bridge the Gaps in the Care Continuum

We thank Dr. Fabienne Marcellin et al. for their interest in our work 1 and for their insightful comments on the significant role of geographical proximity to public hospitals in initiating direct-acting antivirals (DAAs) in France. They rightly highlight the need to re-engage physicians outside hospital settings in DAA prescription, especially considering that fewer than 8% of prescriptions are currently issued by general practitioners (GPs), despite universal prescribing rights being granted since 2019. We fully agree that this educational outreach is essential for achieving HCV elimination, in alignment with the WHO hepatitis elimination strategy 2. Given that most physicians—both in and outside hospitals—are overburdened, innovative strategies are needed to bridge the gaps in the care continuum, from screening to treatment and post-therapy follow-up. This challenge is compounded by the growing issue of medical desertification in France, as well as competing ‘extra-health’ priorities (e.g., social reintegration, substance use cessation, reimbursement uncertainties for migrants) among the so-called high-risk HCV populations, including people who inject drugs, men who have sex with men, incarcerated individuals and patients with psychiatric conditions—who represent the majority of those requiring treatment. Key drivers for improving screening and treatment uptake include increasing awareness and conviction among both patients and physicians regarding the benefits of sustained virological response. These benefits extend beyond hepatic outcomes, encompassing reduced liver-related and overall mortality, fewer vasculitis manifestations and mitigation of chronic inflammation's impact on cardiovascular, cerebrovascular, renal and psychiatric health. Importantly, DAAs offer a cost-effective, well-tolerated and short-duration therapy 3. The individual benefits are further amplified by community-level advantages, notably a reduced risk of HCV transmission and reinfection 4. Innovative approaches to enhance the care cascade vary across countries, depending on prior efforts and national political commitment. In France, for example, a dedicated hotline between GPs and hospital-based HCV specialists could facilitate faster screening (with reflex HCV RNA testing following serology), baseline fibrosis assessment, DAA prescription and post-treatment monitoring. Another way to mitigate the impact of geographical proximity may be to reduce the number of visits required before initiating DAA therapy. A recent study demonstrated that innovative care models—such as test-and-treat or decentralised approaches—significantly improve treatment initiation 5. In France, while fibrosis assessment remains a prerequisite 6, it should not delay access to therapy, particularly since it can be easily performed using simple, non-invasive methods such as the FIB-4 index. Stanislas Pol, Denis Ouzan, Laurent Cattan for the Helios3 cooperative group supported by the study sponsor Gilead Sciences. This work was supported by Gilead Sciences. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.