Clinical Scorecard: Innovative Care Approaches for Hepatitis C: Insights from Southeast Asia and Sub-Saharan Africa
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection
Key Mechanisms
Integrated care models combining decentralization, task-shifting, simplified treatment protocols, and integration into existing health services
Target Population
People with hepatitis C in low- and middle-income countries, especially in Southeast Asia and Sub-Saharan Africa
Care Setting
Decentralized, lower-level health facilities including primary care centers, harm reduction programs, HIV and TB clinics
Key Highlights
Integrated care models (ICMs) improve access, linkage to care, treatment uptake, and cure rates in resource-limited settings.
Task-shifting to trained nonspecialists achieves cure rates comparable to specialists.
Successful country programs (Rwanda, Cambodia, Malaysia, Nigeria) demonstrate feasibility of decentralized, simplified hepatitis C care.
Guideline-Based Recommendations
Diagnosis
Expand HCV testing services through decentralization and integration with existing programs.
Utilize same-day RNA testing where possible to facilitate rapid diagnosis.
Management
Implement task-shifting to nonspecialist doctors and nurses with adequate training.
Use simplified, pangenotypic direct-acting antiviral regimens with shorter courses and fewer side effects.
Integrate hepatitis C care into existing health services such as HIV and TB clinics.
Monitoring & Follow-up
Ensure continuous care and follow-up within the same decentralized centers to improve patient retention and sustained virologic response (SVR).
Employ telemedicine to re-engage patients lost to follow-up.
Risks
Potential challenges include limited funding and infrastructure in some settings.
Nonadopting countries risk falling behind WHO 2030 elimination targets without implementing integrated care models.
Patient & Prescribing Data
HCV-infected individuals in low- and middle-income countries, including rural and marginalized populations
High SVR12 rates (above 90%) achieved with decentralized, nurse-led, and task-shifted care using pangenotypic DAAs; same-day test-and-treat approaches improve uptake.
Clinical Best Practices
Leverage existing health infrastructure (e.g., HIV, TB programs) to integrate hepatitis C services.
Negotiate access to low-cost DAAs to enable scale-up in resource-constrained settings.
Adopt WHO-aligned policies focusing on decentralization, integration, task-shifting, and simplified protocols.
Provide continuous training and capacity-building for nonspecialist providers.
Use telemedicine to support decentralized care and patient retention.
The CDC has dropped routine recommendations for six childhood vaccines, shifting decisions to parents and doctors despite decades of evidence showing the shots prevented millions of hospitalizations and tens of thousands of deaths.
