Is HCV screening working in Italy? Data from a Local Health Unit in the Metropolitan City of Rome

Abstract Background Hepatitis C Virus (HCV) remains a public health issue in Europe, with Italy being one of the countries with the highest prevalence. In line with the national HCV elimination strategy, a one-time screening program targeting individuals born between 1969 and 1989 was implemented across the country. This study presents data from Local Health Unit (LHU) Roma 2 in the Metropolitan City of Rome, covering the period from January 2022 to April 2025. Methods Approximately 375,000 residents in the territory of the LHU Roma 2 born between 1969 and 1989 were invited by letter to participate in free HCV screening. Testing included HCV antibody detection, followed by reflex RNA testing in antibody-positive cases. Results A total of 35,610 individuals underwent screening, resulting in a 9.5% participation rate. Of these, 289 (0.81%) tested positive for HCV antibodies. Reflex testing confirmed active infection (RNA+) in 41 individuals (14.2% of Ab+; 0.12% of all screened). Conclusions The detection rate is consistent with national estimates for Italy (0.1-0.15%) and aligns with figures reported in other European countries with similar birth-cohort screening strategies. However, it remains lower than overall national HCV prevalence estimates (0.66%), suggesting that limiting screening to a single age cohort may miss a substantial number of infections. Broader or risk-based strategies, including older age groups or high-risk populations, may be more effective in identifying undiagnosed cases. Increasing participation and integrating screening into routine healthcare services will be essential to reach HCV elimination goals. Key messages • The observed rate of active HCV infection is lower than estimates for the general population in Italy. • Current screening criteria in Italy may miss a substantial number of infections.