Regionalised approach to national HCV screening in Italy: a focus on Tuscany

Abstract Background Structured HCV care pathways are key to enhance screening and treatment. The screening phase is crucial for identifying undiagnosed infections, particularly among high-risk groups. In Italy, Law 28/2020 introduced free HCV screening for the 1969-1989 birth cohort and selected vulnerable populations. However, due to the regionalized health system, implementation varies, raising equity and efficiency challenges. Methods Within the project ‘Monitoring and Analyzing Regional Indicators of HCV Screening to Improve Screening and Achieve the WHO Target of HCV Elimination by 2030’, funded by the Italian Ministry of Health, regional screening models are compared. This abstract focuses on Tuscany, where structured screening strategies were implemented across the general population, people who use drugs (PWUD), and people living in prison (PLP). Results In Tuscany, the regional model integrates multiple access points, data, and reflex RNA testing. Between 2023 and 2024, the TestiamoCi campaign screened 60,817 individuals in the general population, with a 0.5% anti-HCV positivity rate, using rapid tests in pharmacies, general practices, and NGOS. Over 715,000 people were invited, with central data collection via the ‘#screeningHCV’ app. Opportunistic hospital-based screening at AOUP reached positivity rates up to 3.5% in medical wards. Among PWUD (n = 24,331 invited) and people living in prison (n = 10,352 invited), tailored outreach strategies were employed, with defined linkage-to-care pathways. Conclusions Tuscany's multi-layered approach demonstrates that decentralized, diversified, and data-driven screening strategies can effectively reach target populations and ensure linkage to care. Comparative analysis of regional models, as promoted by the abovementioned project, is essential to identify and harmonize best practices for the organization and implementation of services to ultimately advance HCV elimination with equity and cost-effectiveness. Key messages • Regional implementation variability affects the equity and efficiency of HCV screening in Italy, underlining the need for comparative evaluations and best practice sharing. • Harmonizing regional approaches, while respecting local contexts, is essential to optimize cost-effectiveness, equity, and ultimately achieve the WHO HCV elimination target by 2030.