Decentralised Hepatitis C Management: A Simplified, Integrated Model of Care in a Primary Health Centre in Pakistan, August 2022–June 2023

Pakistan has the world's highest hepatitis C virus (HCV) prevalence, yet access to HCV care remains limited. In collaboration with the Ministry of Health Sindh, Médecins Sans Frontières implemented a simplified, decentralised model for HCV screening and treatment at a government-run primary health centre (PHC) in Baldia Town, Karachi, Pakistan. This cohort study assessed treatment uptake, effectiveness, and retention among patients screened between August 2022 and July 2023. Individuals aged ≥ 12 years were screened using capillary blood rapid diagnostic tests, with HCV viraemia confirmed via GeneXpert. Viraemic patients were treated with 12- or 24-week regimens of sofosbuvir (400 mg) and daclatasvir (60 mg), depending on the fibrosis degree. Cure was defined as a sustained virological response (viral load < 10 IU/mL) at 12 weeks post-treatment (SVR12). Among 3505 individuals screened, 613 (17.5%) tested HCV-antibody positive. Of these, 610 received confirmatory viral load testing, revealing 225 (37.9%) HCV RNA positive. A total of 161 (71.6%) initiated treatment, with a median time of 5 days (IQR 2-9) from diagnosis, while 23 (10.2%) were deemed ineligible and 41 (18.2%) lost to follow-up. Of the 118 patients assessed for SVR12, 114 (96.6%) achieved cure. Overall, 91.3% of those who started treatment completed it. These findings demonstrate the effectiveness of decentralised, primary care-based HCV management in a high-burden, resource-limited setting. The model appears feasible in terms of patient-level outcomes, though broader operational feasibility-including resources and scalability-was not formally assessed. Remaining barriers to treatment initiation and follow-up need to be addressed to advance national HCV elimination goals.