HCV screening among surgical patients in a tertiary hospital of Northern China

This study identifies a critical breakdown in the hepatitis C virus (HCV) care cascade at our institution, where a substantial "diagnostic gap" resulted in only 33.63% of anti-HCV positive patients receiving confirmatory RNA testing. The high seroprevalence (2.03%) in our pre-operative cohort, particularly among males and the elderly (peaking at 3.64% in the 70-79 age group), underscores the need for targeted screening. The primary barrier was identified as a fundamental incompatibility between the two-step diagnostic process and clinical workflows, with short hospital stays (≤ 7 days) being the strongest negative predictor. This systemic failure, observed across various non-hepatology departments, contrasts sharply with high performance in settings like Nephrology (87.80% testing rate) and mirrors challenges reported globally. Conversely, downstream linkage to care proved successful, with hepatology referral rates rising to 66.67% in 2024, demonstrating the effectiveness of structured, technology-driven interventions like electronic referral systems. These findings advocate for fundamental system-level reforms, including the implementation of reflex RNA testing, intelligent EMR alert systems, and performance-linked quality metrics, to bridge the diagnostic gap and advance progress towards HCV elimination goals.