Screening for Hepatitis C Virus in Surgical Patients at a Tertiary Care Facility in Northern China

Overview

A retrospective study of 114,968 surgical patients at a tertiary hospital in Northern China evaluated the effectiveness of a hepatitis C virus (HCV) micro-elimination program. The program implemented universal antibody screening, rapid RNA confirmatory testing, and mandatory specialist referral, revealing key gaps in RNA testing completion and linkage to care within 72 hours of positive antibody results.

Background

Hepatitis C virus infection affects an estimated 10 million people in China, with many cases remaining undiagnosed due to the asymptomatic nature of chronic infection. Early detection and treatment with direct-acting antivirals can achieve cure rates above 95%, reducing morbidity and healthcare costs. The World Health Assembly has set ambitious elimination targets for 2030, but China currently faces low diagnosis and treatment rates. To address this, a micro-elimination program was launched focusing on universal screening, timely RNA testing, and specialist referral within a tertiary care setting.

Data Highlights

Key Findings

• Universal anti-HCV antibody screening was implemented for all surgical admissions as part of routine preoperative testing.
• Physician-mandated HCV RNA testing was required within 72 hours of a positive antibody result to confirm active infection.
• Mandatory in-hospital referral to hepatology or infectious diseases specialists was enforced for patients with confirmed HCV RNA positivity.
• Compliance with RNA testing and specialist referral was monitored in real-time using an integrated electronic health record system and centralized registry.
• Significant gaps were identified in the completion of RNA testing and linkage to care, particularly outside hepatology and gastroenterology departments.
• Manual audit of 200 randomly selected records confirmed high data fidelity, supporting the reliability of findings.

Clinical Implications

Routine universal screening for HCV in surgical patients can identify undiagnosed infections, but timely confirmatory RNA testing and specialist referral are critical to effective care linkage. Real-time monitoring and enforced protocols help improve adherence, yet targeted interventions are needed in non-specialty departments to close gaps. Early identification and linkage to care facilitate prompt treatment initiation, aligning with national and global elimination goals.

Conclusion

The study demonstrates that a structured micro-elimination program incorporating universal screening, rapid RNA testing, and mandatory specialist referral is feasible in a large tertiary care setting. Addressing identified failures in the care cascade, especially RNA testing completion, is essential to optimize HCV diagnosis and linkage to care among surgical patients.

References

1. World Health Assembly 2022–2030 Global Health Sector Strategy on Viral Hepatitis
2. National HCV diagnosis and treatment rates in China 2024
3. Direct-acting antiviral regimens achieving >95% cure rates