Innovative management of hepatitis C: implementation and outcomes of the ‘SMART’ model in a general hospital

Background: This study aimed to evaluate the implementation and outcomes of the hepatitis C (HCV) SMART management model in a tertiary hospital, to provide insights for optimising HCV management globally. Methods: tests and multivariable generalised estimating equations (GEE) to account for department-level clustering. Results: A total of 355,191 patients were screened, with 4,355 (1.23%) testing anti-HCV-positive. Males and patients born before 1997 had significantly higher positivity rates. Blood-borne transmission was the predominant risk factor in the pre-1997 cohort. The Micro-Elimination Model increased the HCV RNA testing rate (53.76% vs. 58.33%, P = 0.014) but not the DAA treatment rate (65.33% vs. 64.21%, P = 0.780). In contrast, the SMART Model significantly improved both outcomes: the RNA testing rate rose to 77.10% (P < 0.001) and the DAA treatment rate to 71.29% (P = 0.044). Multivariable GEE analysis identified age <60 years, care in the Department of Infectious Diseases, and the SMART Model as positive independent predictors for both HCV RNA testing and DAA treatment initiation. Conclusions: The SMART Model significantly enhanced HCV diagnosis and treatment rates while improving clinical management. Future efforts should focus on disseminating this model to optimise healthcare resources and strategies.