Comparative Impact of Active Versus Passive Surveillance on Hepatitis C Virus Testing Uptake, Diagnosis and Linkage to Care in Low‐ and Middle‐Income Countries: A Systematic Review and Meta‐Analysis

ABSTRACT Background Hepatitis C virus (HCV) infection remains a major global health challenge, particularly in low‐ and middle‐income countries (LMICs), where limited diagnostic access and weak surveillance hinder progress toward the World Health Organization's 2030 elimination targets. This review compared the effectiveness of active versus passive surveillance on HCV testing uptake, diagnosis, and linkage to care in LMICs. Methods A systematic review and meta‐analysis were conducted in accordance with PRISMA 2020 guidelines. Studies published between 2000 and July 2025 were retrieved from eight databases, including PubMed, Scopus, and EMBASE. Eligible studies reported HCV testing, diagnosis, or linkage outcomes among adults (≥ 18 years) in LMICs. We conducted the meta‐analysis using the random‐effects model to estimate pooled prevalence, and qualitative findings were thematically synthesised. Results Forty‐four studies met the inclusion criteria, of which 17 conducted across 21 countries in Sub‐Saharan Africa and South and Southeast Asia contributed to the meta‐analysis, reflecting regional rather than global estimates of HCV‐RNA prevalence. The pooled HCV‐RNA prevalence was 53.4% (95% CI: 32.8–74.1; I 2 = 99.9%). Active surveillance interventions commonly included mobile outreach ( n = 7), community screening ( n = 12), integration of testing into HIV or TB services ( n = 13), or provider‐initiated testing ( n = 10), with active approaches achieving higher diagnostic yields and uptake than passive facility‐based models. Key barriers included stigma, limited infrastructure, and weak referral systems, while facilitators involved decentralisation, integration with HIV/TB services, and point‐of‐care diagnostics. Conclusion Active surveillance substantially improves HCV detection and care linkage compared to passive approaches. However, sustainable hybrid systems that combine both models, strengthen laboratories, and engage the community are essential to achieve equitable progress toward HCV elimination in LMICs.