Hepatitis C elimination protocol in Cantabria: Updated regional strategy and outcomes from a population-based cohort and opportunistic screening programs

Thanks to the emergence of direct-acting antiviral agents, Hepatitis C (hepatitis C virus (HCV)) elimination is a real possibility. In 2016, the World Health Organization established a global strategy with the aim of achieving HCV elimination by 2030. However, the actual implementation of this strategy within healthcare systems worldwide has proven challenging, and the COVID-19 pandemic nearly completely halted HCV elimination programs. Seroprevalence studies in the general population attending health centers in Spain place us as a low-prevalence country, but recent reports have shown that the Emergency Department and hospital population show significantly higher prevalence rates, suggesting that studies in the general population may underestimate the true prevalence, especially in vulnerable people. Thus, HCV screening should be implemented through a combination of approaches: population-based programs, self-referral options, and opportunistic testing during any healthcare encounter. Here, we summarize the main updates to the measures adopted in the Strategy for the Elimination of Hepatitis C in Cantabria, a region in northern Spain, so that they can serve as inspiration for other regions. The update prespecifies primary operational and virological endpoints (coverage, linkage‑to‑care, time‑to‑treatment, and sustained virological response 12 (SVR12)), and secondary clinical outcomes, and it includes a pragmatic economic assessment (cost per diagnosis/SVR and budget impact).