Background: The discovery of the hepatitis C virus (HCV) and direct-acting antiviral (DAA) drugs is one of the major milestones in the last 3 decades of medicine. These discoveries encouraged the World Health Organization (WHO) to set an ambitious goal to eliminate HCV by 2030, meaning “a 90% reduction in new cases of chronic HCV, a 65% reduction in HCV deaths, and treatment of 80% of eligible people with HCV infections.” Summary: This review summarizes the key achievements from the discovery of HCV to the development of effective treatment and global elimination strategies. A better understanding of HCV structure, enzymes, and lifecycle led to the introduction of new drug targets and the discovery of DAA. Massive public health interventions are required, such as screening, access to care, treatment, and post-care follow-up, to make the most of DAA’s potential. Screening must be supported by fast, accessible, sensitive, specific HCV diagnostic tests and noninvasive methods to determine the stage of liver disease. Linkage to care and treatment access are critical components of a comprehensive HCV elimination program, and decentralization plays a key role in ensuring their effectiveness. Key Messages: Effective and simple screening strategies, rapid diagnostic tools, linkage to health care, and accessible treatment are key elements to achieving the WHO’s goal. Incorporating treatment as prevention strategies into elimination programs together with preventive education and harm reduction interventions can have a profound and lasting impact on reducing both the incidence and prevalence of HCV. However, WHO’s goal can be challenging to implement because of the need for high financial resources and strong political commitment.

It is estimated that 71 million people are chronically infected with the hepatitis C virus (HCV) [1], including more than 5 million people in Europe [2]. HCV infection becomes chronic in most cases, has a major impact on quality of life, and can lead to serious and deadly complications, such as liver cirrhosis and hepatocellular carcinoma [3], and 400,000 people die of HCV-related complications every year [4]. Because of the steadily growing burden of the disease, in 2016 the WHO approved the global strategy to eliminate HCV infection by 2030 [1]. To achieve this target, the WHO plans to obtain “a 90% reduction in new cases of chronic hepatitis C, a 65% reduction in hepatitis C deaths, and treatment of 80% of eligible people with chronic hepatitis C infections” [5, 6]. Hepatitis C virus discovery, simple and accurate diagnostic tools, treatment options, and breakthroughs brought by direct-acting antiviral (DAA) drugs are major achievements that make the WHO’s goal possible. However, public health interventions, economic resources, and political commitment are major challenges to achieving this goal.

The first important discovery in HCV history was made in 1965, when Blumberg et al. [7] determined Australia antigen, which now is known as hepatitis B virus (HBV) surface antigen and was considered to be the main cause of serum hepatitis [7‒9]. The existence of HCV was fully recognized in 1975 by Feinstone et al. [10], who detected hepatitis A virus in stool. After the development of serological hepatitis A virus and HBV tests, HCV was then named “non-A, non-B” hepatitis (NANBH) [11]. Subsequent chimpanzee studies showed that NANBH is a small enveloped agent and leads to the progression of liver cirrhosis and hepatocellular carcinoma [12‒15]. In 1989, Houghton and colleagues cloned and sequenced the NANBH genome and called it HCV [16, 17]. The 2020 Nobel Prize in Physiology or Medicine was awarded to Harvey J. Alter, Michael Houghton, and Charles M. Rice for the discovery of HCV. Genetic analysis has shown that HCV exhibits high genetic heterogeneity and was first classified into 6 genotypes [18, 19], but recent studies have identified additional rare genotypes 7 [20] and 8 [21]. HCV genotypes 1 and 3 are the most prevalent genotypes and account for 46% and 30% of all HCV cases, respectively; genotypes 2, 4, 5, and 6 accounted for the majority of remaining cases: 9%, 8%, 1%, and 6%, respectively [22]. The first HCV treatment option was interferon-α2b (INF-α) [23], which was effective in disease activity reduction [24‒26] and later officially approved for chronic hepatitis C treatment. IFN-α binds to a receptor expressed on the surface of the target cells, which leads to the activation of the Jak-STAT signaling pathway. IFN does not exhibit a direct antiviral action but induces gene products which, in turn, act against the virus. The mechanism of action of ribavirin has not yet been completely understood, although it is clear that it improves interferon efficacy by direct antiviral activity, immunomodulation, and mutations of the viral genome [27]. However, a high relapse rate, frequent side effects, and an average sustained viral response [28] were major drawbacks. Later, combined INF-α and ribavirin therapy was introduced and became the standard treatment option in 1999 [29‒31]. To maintain a steady level of an active drug and reduce the frequency of administration, pegylated INF-α2b (PegINF-α) was developed. Following studies showed that PegINF-α was superior to the unpegylated IFN [32] and a new combination of PegINF-α and ribavirin became the standard choice of hepatitis C treatment for the next 10 years. However, this therapy had only a modest response rate of up to 55% and was associated with low tolerability due to side effects (flu-like symptoms, hematological toxicity, elevated transaminases, nausea, and fatigue) [33, 34]. Moreover, in genotypes 1 and 4 the rates of viral response did not surpass 50% and were only slightly higher in the other genotypes [35]. A better understanding of HCV structure, enzymes, and lifecycle led to the introduction of new drug targets and the discovery of DAA. In 2014, the United States Food and Drug Administration (FDA) approved the first all-DAA regimen [36‒39]. Before starting full interferon-free regimens, sofosbuvir bitherapy with PegINF-α and ribavirin was introduced and showed a sustained virologic response (SVR) of 90% in genotype 1; however, the side effects were those expected with biotherapy [35]. In general, DAAs can be divided into three major classes based on their targets in HCV proteins: the nonstructural protein 3/4A (NS3/4A) protease inhibitors that can inhibit HCV polyprotein processing; NS5A inhibitors, inhibiting viral replication and assembly and NS5B polymerase inhibitors that can block HCV RNA replication [40]. Today, recommended regimens depending on the stage of liver disease and viral genotype are sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir, glecaprevir/pibrentasvir, and grazoprevir/elbasvir [41]. The main goal of HCV treatment with DAA is the SVR defined as undetectable HCV RNA 12 weeks after the end of treatment [41, 42]. According to multiple studies, relapse following SVR after 12 weeks posttreatment is very rare and occurs in less than 1% of patients who complete treatment [43]. SVR is related to reduced morbidity and mortality and improves quality of life. DAA therapy regimens are short (usually 8–12 weeks, while PegINF-α and ribavirin needed treatment duration of 24–48 weeks), have no or mild side effects, and can be used in patients with decompensated cirrhosis, after liver transplantation, HBV co-infection, or significant comorbidities. Moreover, today first-line pan-genotypic regimens show excellent treatment results against all HCV genotypes. HCV genotypes 1a, 1b, 2, 3, 4, 5, and 6 are treated with sofosbuvir/velpatasvir for 12 weeks or with glecaprevir/pibrentasvir for 8 weeks, while grazoprevir/elbasvir is recommended for genotype 1b only for 12 weeks [41]. In the case of genotype 3 with compensated liver cirrhosis, ribavirin should be added to sofosbuvir/velpatasvir or glecaprevir/pibrentasvir duration should be extended to 16 weeks [41]. In the case of failure of first-line DAA treatment, effective combination therapy of sofosbuvir, velpatasvir, and voxilaprevir is approved for the retreatment [42, 43]. Indeed, the availability of efficient DAAs with high cure rates has revolutionized HCV treatment. In 2016, the WHO launched an ambitious global program to achieve HCV elimination by 2030.

Every year, new cases of HCV outnumber the mortality rates of end-stage liver disease. The advent of DAA is one of the major discoveries in medicine which makes the WHO’s goal to eliminate hepatitis C possible. It is noted that the WHO calls not for disease eradication but for elimination which is defined as the reduction to zero incidence of infection caused by a specific agent in a defined geographic area as a result of deliberate effort [44]. To achieve this target, the WHO plans to obtain “a 90% reduction in new cases of chronic hepatitis C, a 65% reduction in hepatitis C deaths, and treatment of 80% of eligible people with chronic hepatitis C infections” [5, 6]. Mathematical models already showed that hepatitis C could be eliminated if the WHO targets are met [45, 46]; moreover, HCV meets the criteria that make elimination feasible: humans are essential reservoirs for the virus, it does not amplify in the environment, simple and accurate tests can identify the virus, and effective interventions can interrupt and cure both acute and chronic infections and stop transmission [47]. The WHO identified critical impact and coverage indicators, as well as milestones needed to achieve elimination by 2030, that are summarized in Table 1 [48]. Massive public health interventions are required, such as screening, access to care, treatment, and post-care follow-up, to make the most of DAA’s potential at the population level [1].

Table 1.

WHO indicators and milestones needed to achieve HCV elimination [48]

IndicatorBaseline – 2020Targets – 2025Targets − 2030
Impact 
 Number of new hepatitis C infections per year 1.575 million new cases 1 million new cases 350,000 new cases 
20 per 100,000 13 per 100,000 5 per 100,000 
 Number of new hepatitis C infections per year among PWID 8 per 100 3 per 100 2 per 100 
 Number of deaths due to hepatitis C per year 290,000 deaths 240,000 deaths 140,000 deaths 
Coverage 
 Percentage of people living with diagnosed hepatitis C/people cured, % 30/30 60/50 90/80 
 Number of needles and syringes distributed per person who injects drugs 200 300 300 
 Blood safety – the proportion of blood units screened for bloodborne diseases, % 95 100 100 
 Safe injections – the proportion of safe healthcare injections, % 95 100 100 
Milestones 
 Planning – number of countries with hepatitis elimination plans To be determined 30 50 
 Surveillance – number of countries reporting disease burden annually 130 150 170 
 HCV drug access – the percentage of average reduction in prices (to equivalent generic prices by 2025), % 20 50 60 
 Elimination – number of countries validated for elimination of hepatitis C and/or hepatitis B 20 
 Integration – the proportion of people living with HIV tested for/and cured from hepatitis C, % To be determined 60/50 90/80 
IndicatorBaseline – 2020Targets – 2025Targets − 2030
Impact 
 Number of new hepatitis C infections per year 1.575 million new cases 1 million new cases 350,000 new cases 
20 per 100,000 13 per 100,000 5 per 100,000 
 Number of new hepatitis C infections per year among PWID 8 per 100 3 per 100 2 per 100 
 Number of deaths due to hepatitis C per year 290,000 deaths 240,000 deaths 140,000 deaths 
Coverage 
 Percentage of people living with diagnosed hepatitis C/people cured, % 30/30 60/50 90/80 
 Number of needles and syringes distributed per person who injects drugs 200 300 300 
 Blood safety – the proportion of blood units screened for bloodborne diseases, % 95 100 100 
 Safe injections – the proportion of safe healthcare injections, % 95 100 100 
Milestones 
 Planning – number of countries with hepatitis elimination plans To be determined 30 50 
 Surveillance – number of countries reporting disease burden annually 130 150 170 
 HCV drug access – the percentage of average reduction in prices (to equivalent generic prices by 2025), % 20 50 60 
 Elimination – number of countries validated for elimination of hepatitis C and/or hepatitis B 20 
 Integration – the proportion of people living with HIV tested for/and cured from hepatitis C, % To be determined 60/50 90/80 

According to the WHO data, approximately only about 5% of people with chronic hepatitis C know their disease status [1]. In 2017, only about 5% of people with chronic hepatitis C knew their disease status [1]. Access to HCV treatment is improving, and of the 58 million people living with HCV infection globally in 2019, an estimated 21% (15.2 million) knew their diagnosis [49]. National plans with effective screening strategies to effectively find infected people are critical to accomplish the abovementioned WHO objectives. However, to achieve macro-elimination of HCV, an entire or large segment of a country’s population with a historically high prevalence of HCV infection must be screened [50, 51]. In Europe, where HCV prevalence is less than 2% [52], mass-screening programs are not recommended by the WHO and are not considered cost-effective [50, 53]. Instead, screening could be cost-effective for certain cohorts [54]. It is recommended that populations who are more difficult to reach, for example, people who inject drugs (PWID), homeless, migrants, prisoners, patients with mental health disorders, men who have sex with men, and sex workers, should receive fast HCV diagnosis and staging using transient elastography (FibroScan) and pan-genotypic treatment [41]. To date, few countries have followed the mass-screening approach, including Egypt, where more than 50 million people were screened for HCV and several million were treated [55], and in the USA, a budget for a national elimination program was approved in 2023 and mass screening will be launched in 2024 [56]. Smaller countries such as Georgia, Iceland, and Lithuania also launched excellent mass-screening national programs; moreover, in Iceland additional harm reduction programs and increased distribution of sterile needles and syringes showed promising results, and HCV elimination is expected before 2030 [57‒59]. While the goal of complete elimination in high-income Western countries is possible, however, it can be difficult in high-prevalence countries with limited resources. A micro-elimination strategy approach can be useful, where specific subpopulations are targeted instead of the mass-screening program. These populations are mainly migrants from high-prevalence countries, PWID, prisoners, men who have sex with men, baby boomers, HIV co-infected patients, psychiatric patients, and target groups such as patients with advanced liver disease, hemophiliacs, and those treated with hemodialysis [60]. In 2016, Australia became one of the first countries in the world to announce a national strategy to eliminate hepatitis C. The strategy includes expanding access to testing and treatment, especially for marginalized communities, and increasing public awareness. In Europe, countries that followed micro-elimination approach and are currently on track to achieve elimination by 2030 are Denmark, Finland, France, Norway, Spain, the UK, and others (Italy, the Netherlands, Belgium, Malta, Slovakia, Luxembourg, Switzerland, Germany, Austria, Ireland, and Hungary) that are working toward HCV elimination, which is expected between 2031 and 2050 [61].

Screening strategies must be supported by fast, easily accessed, sensitive, specific HCV diagnostic tests and noninvasive methods to determine the stage of liver disease. Currently, HCV is diagnosed using anti-HCV antibodies and HCV RNA to confirm active disease [62]. This is a two-step process, which requires multiple visits, phlebotomy services, and specialized laboratories. The development of more accessible tests that do not require elaborate laboratories is a huge step in simplifying screening and diagnosis. This can help facilitate testing in areas outside the hospital and healthcare centers, making it easier for individuals to get tested. However, it is important to note that while these tests may be easier to use, specific training of healthcare personnel is still required to ensure accurate results. Exciting development in diagnostic testing is the possibility of point-of-care testing [63]. This type of testing can be particularly useful in settings where access to traditional laboratory testing is limited (e.g., prison and services for PWID) [64]. Examples of point-of-care tests include rapid tests from saliva or blood, which can provide on-site anti-HCV and/or HCV RNA results in a matter of minutes, or dried blood spot, which requires laboratory processing [65, 66].

Linkage to care and treatment access are critical components of a comprehensive hepatitis C elimination program, and decentralization strategies play a key role in ensuring their effectiveness. Decentralization involves shifting healthcare services and resources from centralized facilities to a network of local healthcare providers and community-based organizations, which helps individuals in remote or underserved areas gain improved access to HCV diagnosis and treatment [67]. This approach not only reduces geographical barriers but also enhances the efficiency of the healthcare system by distributing the workload across multiple providers [68]. Decentralization efforts often involve training healthcare professionals at various levels of the healthcare system to diagnose, treat, and manage HCV effectively [68]. Restrictions for DAA indications should be omitted and prescription barriers should be removed in order to have not only hepatology and infectious disease specialists but also general practitioners and nurses engaged in providing and monitoring hepatitis treatment [69]. Moreover, community engagement and awareness campaigns are essential in decentralization, as they empower individuals with knowledge about HCV prevention and available treatment options. The affordability of hepatitis C treatment plays a major role in successful elimination efforts [70]. High prices for antiviral medications have historically posed a significant barrier, limiting the number of individuals who can access and complete treatment [71]. Negotiating with pharmaceutical companies to secure lower prices, promoting generic competition, and implementing cost-effective production methods are some of the approaches that can be pursued [69]. The availability of hepatitis C treatment is linked to a country’s economic situation and access to reimbursement [72]. The high cost of treatment is often driven by patents held by pharmaceutical companies [68], making insurance reimbursement difficult to achieve in low- and middle-income countries (LMICs). Global access to DAA reimbursement remains uneven, with LMICs having comparatively low reimbursement compared with high-income countries (Table 2). To meet the WHO’s goals for HCV elimination, efforts should be made to assist countries, particularly LMICs, to increase access to DAA reimbursement and remove reimbursement restrictions – especially prescriber-type restrictions – to ensure universal access [72]. Efforts to address this issue have included advocacy for fair pricing, voluntary licensing agreements, and challenges to patent validity [73]. Access to treatment is important not only because of its curative effects; treatment of HCV can also serve as a powerful tool for prevention [74]. Studies have shown that successful treatment of individuals with HCV not only improves their individual health outcomes but also significantly reduces the risk of onward transmission [74, 75]. By achieving SVR, individuals are considered noninfectious, thereby breaking the chain of transmission. This “treatment as prevention” approach is particularly impactful in high-risk populations, such as PWID, where the majority of new HCV infections occur [74‒76].

Table 2.

Examples of countries with different income levels for registered and reimbursed DAA medicines for HCV infection

Sofosbuvir– velpatasvirSofosbuvir– velpatasvir–voxilaprevirGlecaprevir– pibrentasvirSofosbuvir– daclatasvirSofosbuvir
High-income countries 
 Germany 1, 2 1, 2 1, 2 1, 2 
 Czech Republic 1, 3 1, 3 1, 3 
 Japan 1, 2 1, 2 1, 2 
 USA 1, 2 1, 2 1, 2 1, 2 
Upper middle-income countries 
 Bulgaria 1, 3 1, 3 1, 3 
 Turkey 1, 3 
 Brazil 1, 2 1, 2 1, 2 1, 2 
 China 1, 3 1, 3 
Lower middle-income countries 
 Ukraine 1, 2 1, 2 1, 2 
 Mongolia 1, 3 1, 3 
 Bolivia 1, 3 1, 3 
 Angola 
Low-income countries 
 Madagascar 
 DR Congo 
 Mali 
 Ethiopia 
Sofosbuvir– velpatasvirSofosbuvir– velpatasvir–voxilaprevirGlecaprevir– pibrentasvirSofosbuvir– daclatasvirSofosbuvir
High-income countries 
 Germany 1, 2 1, 2 1, 2 1, 2 
 Czech Republic 1, 3 1, 3 1, 3 
 Japan 1, 2 1, 2 1, 2 
 USA 1, 2 1, 2 1, 2 1, 2 
Upper middle-income countries 
 Bulgaria 1, 3 1, 3 1, 3 
 Turkey 1, 3 
 Brazil 1, 2 1, 2 1, 2 1, 2 
 China 1, 3 1, 3 
Lower middle-income countries 
 Ukraine 1, 2 1, 2 1, 2 
 Mongolia 1, 3 1, 3 
 Bolivia 1, 3 1, 3 
 Angola 
Low-income countries 
 Madagascar 
 DR Congo 
 Mali 
 Ethiopia 

1 – registered; 2 – reimbursed without prescriber-type restrictions; 3 – reimbursed with prescriber-type restrictions. Adapted from Marshall et al. [72].

The monitoring of HCV treatment and posttreatment follow-up are important tools for the long-term success of elimination. Regular monitoring allows healthcare providers to assess treatment completion and outcomes, drug-drug interactions, and adverse events [41, 43]. Close monitoring of patients with decompensated (Child-Pugh B or C) cirrhosis during therapy is required, with the possibility of stopping therapy if there is evidence of worsening decompensation during treatment [41]. Additionally, posttreatment follow-up includes SVR evaluation 12 weeks after the end of treatment to confirm the efficacy of therapy and the need for further follow-up [41, 43]. In cirrhotic patients, an SVR will reduce but not abolish the risk of HCC; thus surveillance for hepatocellular carcinoma and regular portal hypertension evaluation with liver ultrasound are recommended every 6 months regardless of the success of the treatment [41, 43]. Also, patients should be informed about re-infection risks, which are higher in risk groups, particularly in PWID [77]. Scaling up harm reduction programs such as needle and syringe exchange programs and opioid substitution therapy proved to be very effective in lowering HCV transmission rates [78]. However, only 1% of PWID live in countries with high coverage of needle and syringe exchange programs and opioid substitution therapy [79]. Education and awareness campaigns also are important in promoting safe injection practices, advocating for the use of sterile equipment, and encouraging safer sexual behaviors.

It is estimated that an additional 6 billion US dollars will be needed per year to achieve viral hepatitis elimination goals [70]; however, studies suggest that implementation of the hepatitis C elimination strategy can be cost-effective [80]. Insufficient funding for HCV diagnostics, treatment, and harm reduction services is the main barrier, and sustainable financing mechanisms such as health insurance schemes or innovative funding models are urgently needed. Financial support is vital for affected populations and risk groups, because of the high new infection rates. Sustainable financing is inseparable from strong political will. Political commitment serves as the driving force behind the prioritization of resources, development of policies, and coordination of efforts needed to tackle this public health challenge. According to the WHO, in 2017 only 43 of 194 member states had national plans for HCV elimination [1]. Engagement of governments at all levels, fostering partnerships with stakeholders, and creating an environment for the implementation of evidence-based strategies are key components that lead to the successful elimination of the disease.

Some examples of countries with ongoing hepatitis C screening and elimination programs include the following:

  • 1.

    Egypt: This country has one of the highest rates of hepatitis C in the world, with an estimated 10% of the population infected. Egypt conducted a successful HCV screening program that covered more than 50 million residents and treated more than 4 million. It is poised to be the first country in the world to eliminate HCV within its borders. The lessons learned from this experience can inform the elimination plans of other LMICs with high HCV burdens [55].

  • 2.

    Iceland: Most of the people living with HCV in Iceland are PWID. In 2016, Iceland launched a nationwide project for HCV elimination together with harm reduction programs. This led to an 80% decrease in prevalence among PWID. These achievements position Iceland to be among the first nations to subsequently achieve the WHO’s goal of eliminating HCV as a public health threat [58].

  • 3.

    Australia: One of the first countries to introduce government-funded unrestricted access to DAA therapy, with 88,790 treated since March 2016, is Australia. However, treatment uptake is declining, which could potentially undermine Australia’s progress and create a barrier to achieving all WHO HCV elimination targets by 2030 [81].

  • 4.

    India: This country launched a national hepatitis C program in 2018 to screen 5 million people and treat 300,000 patients in 3 years and has committed to the scale-up of the program, with a government budget supplemented with state-level financing [82].

  • 5.

    USA: In 2016, the US Department of Health and Human Services released a national action plan for the elimination of hepatitis C. From 2014 to 2019, more than 1.2 million patients were treated for HCV in the USA. Elimination targets in 2030 could be achieved in the USA by treating an additional 3.2–3.3 million patients from 2020 to 2030. The USA has made strides toward HCV elimination, but gains could be lost in the wake of the COVID-19 pandemic. However, it is still possible to avert nearly 30,000 deaths through increased harm reduction and increased treatment rates. This requires a coordinated effort from the entire HCV community [83].

  • 6.

    Spain: In 2019, Spain launched a national hepatitis C elimination plan that aims to reduce the prevalence of hepatitis C by 90%. Strong multidisciplinary support and political commitment have helped Spain become one of the countries most likely to eliminate hepatitis C. Six key elements, including micro-elimination efforts and opportunistic screening with hepatitis C serological tests for all individuals seeking healthcare services, could serve as a model elsewhere [84].

  • 7.

    Germany: In 2018, Germany launched a national strategy to eliminate hepatitis C by 2030. The HCV elimination strategy in Germany (BIS 2030) includes advice and implementation through nongovernment organizations and companies rather than governmental-initiated or organized projects. The barriers preventing elimination do not include treatment itself but reaching people, in particular at-risk populations, and engaging them at every aspect of the care cascade, from diagnosis to post-cure surveillance [85].

  • 8.

    Lithuania: In May 2022, the HCV screening program was started by general practitioners. Serological tests are performed in the population born from 1945 to 1994 once per life and annually in risk populations (PWID and HIV-infected patients) [59]. During the first 6 months of the program, 458,980 people (27% of the targeted country population) were tested and positive HCV antibodies were found in 1.6% of people born from 1945 to 1994 and in 32.8% of the risk group. Viremia was detected in 58.2% of patients with positive HCV antibodies. Treating all HCV patients identified during the program would allow reaching the WHO 2030 target by saving 150 lives and preventing 90 new cases of decompensated cirrhosis and 120 cases of hepatocellular carcinoma [86].

  • 9.

    Georgia: In 2015, the national HCV elimination strategy was launched, which incorporated unrestricted access to DAA treatment, HCV screening, public awareness campaigns, surveillance, and monitoring. Between May 2015 and February 2022, 77,168 HCV-infected people in Georgia have been treated through an HCV elimination program. At the current treatment rate (406/month), with 90% reductions in prevalence and incidence in Georgia, the WHO’s goals are achievable by 2030 [57].

The discovery of hepatitis C and the availability of effective and safe drugs to treat and reduce the spread of infection have led to the ambitious WHO plan to eliminate hepatitis C globally by 2030. However, this goal can be challenging to implement because of the need for high financial resources and strong political commitment.

V.B.-B. has no conflict of interest. L.K. has served as a speaker for AbbVie, MSD, Gilead.

No additional funding was received.

L.K. contributed to reviewing and editing the manuscript, data analysis, and writing the original manuscript. V.B.-B. contributed to the visualization of the manuscript, data analysis, and writing the original manuscript. All authors reviewed and approved of the final manuscript.

1.
WHO
.
Global hepatitis report
;
2017
. Available from: https://www.who.int/hepatitis/publications/global-hepatitis-report2017/en/
2.
Papatheodoridis
GV
,
Hatzakis
A
,
Cholongitas
E
,
Baptista-Leite
R
,
Baskozos
I
,
Chhatwal
J
, et al
.
Hepatitis C: the beginning of the end-key elements for successful European and national strategies to eliminate HCV in Europe
.
J Viral Hepat
.
2018
;
25
(
Suppl 1
):
6
17
.
3.
Stanaway
JD
,
Flaxman
AD
,
Naghavi
M
,
Fitzmaurice
C
,
Vos
T
,
Abubakar
I
, et al
.
The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013
.
Lancet
.
2016
;
388
(
10049
):
1081
8
.
4.
World Health Organization
.
World health statistics 2018: monitoring health for the SDGs, sustainable development goals
.
Geneva
:
World Health Organization
;
2018
. Available from: https://apps.who.int/iris/handle/10665/272596
6.
World Health Organization
.
Combating hepatitis B and C to reach elimination by 2030: advocacy brief
.
World Health Organization
;
2016
. Report No.: WHO/HIV/2016.04. Available from: https://apps.who.int/iris/handle/10665/206453
7.
Blumberg
BS
,
Alter
HJ
,
Visnich
S
.
A “new” antigen in leukemia sera
.
JAMA
.
1965
;
191
:
541
6
.
8.
Krugman
S
,
Giles
JP
.
Viral hepatitis. New light on an old disease
.
JAMA
.
1970
;
212
(
6
):
1019
29
.
9.
Prince
AM
.
An antigen detected in the blood during the incubation period of serum hepatitis
.
Proc Natl Acad Sci USA
.
1968
;
60
(
3
):
814
21
.
10.
Feinstone
SM
,
Kapikian
AZ
,
Purceli
RH
.
Hepatitis A: detection by immune electron microscopy of a viruslike antigen associated with acute illness
.
Science
.
1973
;
182
(
4116
):
1026
8
.
11.
Feinstone
SM
,
Kapikian
AZ
,
Purcell
RH
,
Alter
HJ
,
Holland
PV
.
Transfusion-associated hepatitis not due to viral hepatitis type A or B
.
N Engl J Med
.
1975
;
292
(
15
):
767
70
.
12.
Alter
HJ
,
Purcell
RH
,
Holland
PV
,
Popper
H
.
Transmissible agent in non-A, non-B hepatitis
.
Lancet
.
1978
;
1
(
8062
):
459
63
.
13.
Hollinger
B
,
Gitnick
GL
,
Aach
RD
,
Szmuness
W
,
Mosley
JW
,
Stevens
CE
, et al
.
Non-A, non-B hepatitis transmission in chimpanzees: a project of the transfusion-transmitted viruses study group
.
INT
.
1978
;
10
(
1
):
60
8
.
14.
Alter
HJ
,
Purcell
RH
,
Shih
JW
,
Melpolder
JC
,
Houghton
M
,
Choo
QL
, et al
.
Detection of antibody to hepatitis C virus in prospectively followed transfusion recipients with acute and chronic non-A, non-B hepatitis
.
N Engl J Med
.
1989
;
321
(
22
):
1494
500
.
15.
Colombo
M
,
Kuo
G
,
Choo
QL
,
Donato
MF
,
Del Ninno
E
,
Tommasini
MA
, et al
.
Prevalence of antibodies to hepatitis C virus in Italian patients with hepatocellular carcinoma
.
Lancet
.
1989
;
2
(
8670
):
1006
8
.
16.
Choo
QL
,
Kuo
G
,
Weiner
AJ
,
Overby
LR
,
Bradley
DW
,
Houghton
M
.
Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome
.
Science
.
1989
;
244
(
4902
):
359
62
.
17.
Houghton
M
.
Discovery of the hepatitis C virus
.
Liver Int
.
2009
;
29
(
Suppl 1
):
82
8
.
18.
Bukh
J
,
Purcell
RH
,
Miller
RH
.
At least 12 genotypes of hepatitis C virus predicted by sequence analysis of the putative E1 gene of isolates collected worldwide
.
Proc Natl Acad Sci USA
.
1993
;
90
(
17
):
8234
8
.
19.
Bukh
J
,
Miller
RH
,
Purcell
RH
.
Genetic heterogeneity of hepatitis C virus: quasispecies and genotypes
.
Semin Liver Dis
.
1995
;
15
(
1
):
41
63
.
20.
Smith
DB
,
Bukh
J
,
Kuiken
C
,
Muerhoff
AS
,
Rice
CM
,
Stapleton
JT
, et al
.
Expanded classification of hepatitis C virus into 7 genotypes and 67 subtypes: updated criteria and genotype assignment web resource
.
Hepatology
.
2014
;
59
(
1
):
318
27
.
21.
Borgia
SM
,
Hedskog
C
,
Parhy
B
,
Hyland
RH
,
Stamm
LM
,
Brainard
DM
, et al
.
Identification of a novel hepatitis C virus genotype from Punjab, India: expanding classification of hepatitis C virus into 8 genotypes
.
J Infect Dis
.
2018
;
218
(
11
):
1722
9
.
22.
Messina
JP
,
Humphreys
I
,
Flaxman
A
,
Brown
A
,
Cooke
GS
,
Pybus
OG
, et al
.
Global distribution and prevalence of hepatitis C virus genotypes
.
Hepatology
.
2015
;
61
(
1
):
77
87
.
23.
Hoofnagle
JH
,
Mullen
KD
,
Jones
DB
,
Rustgi
V
,
Di Bisceglie
A
,
Peters
M
, et al
.
Treatment of chronic non-A,non-B hepatitis with recombinant human alpha interferon. A preliminary report
.
N Engl J Med
.
1986
;
315
(
25
):
1575
8
.
24.
Di Bisceglie
AM
,
Martin
P
,
Kassianides
C
,
Lisker-Melman
M
,
Murray
L
,
Waggoner
J
, et al
.
Recombinant interferon alfa therapy for chronic hepatitis C. A randomized, double-blind, placebo-controlled trial
.
N Engl J Med
.
1989
;
321
(
22
):
1506
10
.
25.
Davis
GL
,
Balart
LA
,
Schiff
ER
,
Lindsay
K
,
Bodenheimer
HC
,
Perrillo
RP
, et al
.
Treatment of chronic hepatitis C with recombinant interferon alfa. A multicenter randomized, controlled trial
.
N Engl J Med
.
1989
;
321
(
22
):
1501
6
.
26.
Shindo
M
,
Di Bisceglie
AM
,
Cheung
L
,
Shih
JW
,
Cristiano
K
,
Feinstone
SM
, et al
.
Decrease in serum hepatitis C viral RNA during alpha-interferon therapy for chronic hepatitis C
.
Ann Intern Med
.
1991
;
115
(
9
):
700
4
.
27.
Jiménez-Méndez
R
,
Castañeda-Hernández
G
.
Characteristics of hepatitis C treatment with pegylated interferons and ribavirin
.
Ann Hepatol
.
2010
;
9
:
S61
4
.
28.
Poynard
T
,
Marcellin
P
,
Lee
SS
,
Niederau
C
,
Minuk
GS
,
Ideo
G
, et al
.
Randomised trial of interferon alpha2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT)
.
Lancet
.
1998
;
352
(
9138
):
1426
32
.
29.
Brillanti
S
,
Garson
J
,
Foli
M
,
Whitby
K
,
Deaville
R
,
Masci
C
, et al
.
A pilot study of combination therapy with ribavirin plus interferon alfa for interferon alfa-resistant chronic hepatitis C
.
Gastroenterology
.
1994
;
107
(
3
):
812
7
.
30.
Schvarcz
R
,
Ando
Y
,
Sönnerborg
A
,
Weiland
O
.
Combination treatment with interferon alfa-2b and ribavirin for chronic hepatitis C in patients who have failed to achieve sustained response to interferon alone: Swedish experience
.
J Hepatol
.
1995
;
23
(
Suppl 2
):
17
21
.
31.
McHutchison
JG
,
Gordon
SC
,
Schiff
ER
,
Shiffman
ML
,
Lee
WM
,
Rustgi
VK
, et al
.
Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group
.
N Engl J Med
.
1998
;
339
(
21
):
1485
92
.
32.
Lindsay
KL
,
Trepo
C
,
Heintges
T
,
Shiffman
ML
,
Gordon
SC
,
Hoefs
JC
, et al
.
A randomized, double-blind trial comparing pegylated interferon alfa-2b to interferon alfa-2b as initial treatment for chronic hepatitis C
.
Hepatology
.
2001
;
34
(
2
):
395
403
.
33.
Alarfaj
SJ
,
Alzahrani
A
,
Alotaibi
A
,
Almutairi
M
,
Hakami
M
,
Alhomaid
N
, et al
.
The effectiveness and safety of direct-acting antivirals for hepatitis C virus treatment: a single-center experience in Saudi Arabia
.
Saudi Pharm J
.
2022
;
30
(
10
):
1448
53
.
34.
Sleijfer
S
,
Bannink
M
,
Van Gool
AR
,
Kruit
WHJ
,
Stoter
G
.
Side effects of interferon-alpha therapy
.
Pharm World Sci
.
2005
;
27
(
6
):
423
31
.
35.
González-Grande
R
,
Jiménez-Pérez
M
,
González Arjona
C
,
Mostazo Torres
J
.
New approaches in the treatment of hepatitis C
.
World J Gastroenterol
.
2016
;
22
(
4
):
1421
32
.
36.
Afdhal
N
,
Reddy
KR
,
Nelson
DR
,
Lawitz
E
,
Gordon
SC
,
Schiff
E
, et al
.
Ledipasvir and sofosbuvir for previously treated HCV genotype 1 infection
.
N Engl J Med
.
2014
;
370
(
16
):
1483
93
.
37.
Afdhal
N
,
Zeuzem
S
,
Kwo
P
,
Chojkier
M
,
Gitlin
N
,
Puoti
M
, et al
.
Ledipasvir and sofosbuvir for untreated HCV genotype 1 infection
.
N Engl J Med
.
2014
;
370
(
20
):
1889
98
.
38.
Kowdley
KV
,
Gordon
SC
,
Reddy
KR
,
Rossaro
L
,
Bernstein
DE
,
Lawitz
E
, et al
.
Ledipasvir and sofosbuvir for 8 or 12 weeks for chronic HCV without cirrhosis
.
N Engl J Med
.
2014
;
370
(
20
):
1879
88
.
39.
Lawitz
E
,
Sulkowski
MS
,
Ghalib
R
,
Rodriguez-Torres
M
,
Younossi
ZM
,
Corregidor
A
, et al
.
Simeprevir plus sofosbuvir, with or without ribavirin, to treat chronic infection with hepatitis C virus genotype 1 in non-responders to pegylated interferon and ribavirin and treatment-naive patients: the COSMOS randomised study
.
Lancet
.
2014
;
384
(
9956
):
1756
65
.
40.
Zeng
H
,
Li
L
,
Hou
Z
,
Zhang
Y
,
Tang
Z
,
Liu
S
.
Direct-acting antiviral in the treatment of chronic hepatitis C: bonuses and challenges
.
Int J Med Sci
.
2020
;
17
(
7
):
892
902
.
41.
European Association for the Study of the Liver Electronic address easloffice@easlofficeeu
;
Clinical Practice Guidelines Panel: Chair:EASL Governing Board representative:Panel members
.
EASL recommendations on treatment of hepatitis C: final update of the series
.
J Hepatol
.
2020
;
73
(
5
):
1170
218
.
42.
Simmons
B
,
Saleem
J
,
Hill
A
,
Riley
RD
,
Cooke
GS
.
Risk of late relapse or reinfection with hepatitis C virus after achieving a sustained virological response: a systematic review and meta-analysis
.
Clin Infect Dis
.
2016
;
62
(
6
):
683
94
.
43.
AASLD-IDSA HCV Guidance Panel
.
Hepatitis C guidance 2018 update: AASLD-IDSA recommendations for testing, managing, and treating hepatitis C virus infection
.
Clin Infect Dis
.
2018
;
67
(
10
):
1477
92
.
44.
Di Marco
L
,
La Mantia
C
,
Di Marco
V
.
Hepatitis C: standard of treatment and what to do for global elimination
.
Viruses
.
2022
;
14
(
3
):
505
.
45.
Martin
NK
,
Vickerman
P
,
Grebely
J
,
Hellard
M
,
Hutchinson
SJ
,
Lima
VD
, et al
.
Hepatitis C virus treatment for prevention among people who inject drugs: modeling treatment scale-up in the age of direct-acting antivirals
.
Hepatology
.
2013
;
58
(
5
):
1598
609
.
46.
Scott
N
,
McBryde
ES
,
Thompson
A
,
Doyle
JS
,
Hellard
ME
.
Treatment scale-up to achieve global HCV incidence and mortality elimination targets: a cost-effectiveness model
.
Gut
.
2017
;
66
(
8
):
1507
15
.
47.
Hellard
M
,
Schroeder
SE
,
Pedrana
A
,
Doyle
J
,
Aitken
C
.
The elimination of hepatitis C as a public health threat
.
Cold Spring Harb Perspect Med
.
2020
;
10
(
4
):
a036939
.
48.
Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022–2030
. Available from: https://www.who.int/publications-detail-redirect/9789240053779
50.
World Health Organization
.
WHO guidelines on hepatitis B and C testing
.
Geneva
:
World Health Organization
;
2017
. p.
170
. Available from: https://apps.who.int/iris/handle/10665/254621
51.
Coppola
N
,
Alessio
L
,
Onorato
L
,
Sagnelli
C
,
Macera
M
,
Sagnelli
E
, et al
.
Epidemiology and management of hepatitis C virus infections in immigrant populations
.
Infect Dis Poverty
.
2019
;
8
(
1
):
17
.
52.
Polaris Observatory HCV Collaborators
.
Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study
.
Lancet Gastroenterol Hepatol
.
2017
;
2
(
3
):
161
76
.
53.
Sroczynski
G
,
Esteban
E
,
Conrads-Frank
A
,
Schwarzer
R
,
Mühlberger
N
,
Wright
D
, et al
.
Long-term effectiveness and cost-effectiveness of screening for hepatitis C virus infection
.
Eur J Public Health
.
2009
;
19
(
3
):
245
53
.
54.
Williams
J
,
Miners
A
,
Harris
R
,
Mandal
S
,
Simmons
R
,
Ireland
G
, et al
.
Cost-effectiveness of one-time birth cohort screening for hepatitis C as part of the national health service health check program in england
.
Value Health
.
2019
;
22
(
11
):
1248
56
.
55.
Hassanin
A
,
Kamel
S
,
Waked
I
,
Fort
M
.
Egypt’s ambitious strategy to eliminate hepatitis C virus: a case study
.
Glob Health Sci Pract
.
2021
;
9
(
1
):
187
200
.
56.
Fleurence
RL
,
Collins
FS
.
A national hepatitis C elimination program in the United States: a historic opportunity
.
JAMA
.
2023
;
329
(
15
):
1251
2
.
57.
Walker
JG
,
Tskhomelidze
I
,
Shadaker
S
,
Tsereteli
M
,
Handanagic
S
,
Armstrong
PA
, et al
.
Insights from a national survey in 2021 and from modelling on progress towards hepatitis C virus elimination in the country of Georgia since 2015
.
Euro Surveill
.
2023
;
28
(
30
):
2200952
.
58.
Olafsson
S
,
Tyrfingsson
T
,
Runarsdottir
V
,
Bergmann
OM
,
Hansdottir
I
,
Björnsson
ES
, et al
.
Treatment as Prevention for Hepatitis C (TraP Hep C) – a nationwide elimination programme in Iceland using direct-acting antiviral agents
.
J Intern Med
.
2018
;
283
(
5
):
500
7
.
59.
Ciupkeviciene
E
,
Petkeviciene
J
,
Sumskiene
J
,
Dragunas
G
,
Dabravalskis
S
,
Kreivenaite
E
, et al
.
Hepatitis C virus epidemiology in Lithuania: situation before introduction of the national screening programme
.
Viruses
.
2022
;
14
(
6
):
1192
.
60.
Hollande
C
,
Parlati
L
,
Pol
S
.
Micro-elimination of hepatitis C virus
.
Liver Int
.
2020
;
40
(
Suppl 1
):
67
71
.
61.
Countries maps – CDA foundation
. Available from: https://cdafound.org/polaris-countries-maps/
62.
Fourati
S
,
Feld
JJ
,
Chevaliez
S
,
Luhmann
N
.
Approaches for simplified HCV diagnostic algorithms
.
J Int AIDS Soc
.
2018
;
21
(
Suppl 2
):
e25058
.
63.
Grebely
J
,
Applegate
TL
,
Cunningham
P
,
Feld
JJ
.
Hepatitis C point-of-care diagnostics: in search of a single visit diagnosis
.
Expert Rev Mol Diagn
.
2017
;
17
(
12
):
1109
15
.
64.
Hickman
M
,
McDonald
T
,
Judd
A
,
Nichols
T
,
Hope
V
,
Skidmore
S
, et al
.
Increasing the uptake of hepatitis C virus testing among injecting drug users in specialist drug treatment and prison settings by using dried blood spots for diagnostic testing: a cluster randomized controlled trial
.
J Viral Hepat
.
2008
;
15
(
4
):
250
4
.
65.
Calvaruso
V
,
Bronte
F
,
Ferraro
D
,
Reina
G
,
Conte
E
,
Rini
F
, et al
.
Point-of-care HCV RNA testing in the setting of DAA therapy: HCV-FiS (HEpatitis C virus fingerstick study)
.
Liver Int
.
2019
;
39
(
12
):
2240
3
.
66.
Khuroo
MS
,
Khuroo
NS
,
Khuroo
MS
.
Diagnostic accuracy of point-of-care tests for hepatitis C virus infection: a systematic review and meta-analysis
.
PLoS One
.
2015
;
10
(
3
):
e0121450
.
67.
Dhiman
RK
,
Grover
GS
,
Premkumar
M
,
Taneja
S
,
Duseja
A
,
Arora
S
, et al
.
Decentralized care with generic direct-acting antivirals in the management of chronic hepatitis C in a public health care setting
.
J Hepatol
.
2019
;
71
(
6
):
1076
85
.
68.
World Health Organization
.
Progress report on access to hepatitis C treatment: focus on overcoming barriers in low- and middle-income countries
.
World Health Organization
;
2018
. Report No.: WHO/CDS/HIV/18.4. Available from: https://apps.who.int/iris/handle/10665/260445
69.
Marshall
AD
,
Cunningham
EB
,
Nielsen
S
,
Aghemo
A
,
Alho
H
,
Backmund
M
, et al
.
Restrictions for reimbursement of interferon-free direct-acting antiviral drugs for HCV infection in Europe
.
Lancet Gastroenterol Hepatol
.
2018
;
3
(
2
):
125
33
.
70.
Tordrup
D
,
Hutin
Y
,
Stenberg
K
,
Lauer
JA
,
Hutton
DW
,
Toy
M
, et al
.
Additional resource needs for viral hepatitis elimination through universal health coverage: projections in 67 low-income and middle-income countries, 2016-30
.
Lancet Glob Health
.
2019
;
7
(
9
):
e1180
8
.
71.
Lazarus
JV
,
Pericàs
JM
,
Picchio
C
,
Cernosa
J
,
Hoekstra
M
,
Luhmann
N
, et al
.
We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade
.
J Intern Med
.
2019
;
286
(
5
):
503
25
.
72.
Marshall
AD
,
Willing
AR
,
Kairouz
A
,
Cunningham
EB
,
Wheeler
A
,
O’Brien
N
, et al
.
Direct-acting antiviral therapies for hepatitis C infection: global registration, reimbursement, and restrictions
.
Lancet Gastroenterol Hepatol
.
2024
;
9
(
4
):
366
82
.
73.
Simmons
B
,
Cooke
GS
,
Miraldo
M
.
Effect of voluntary licences for hepatitis C medicines on access to treatment: a difference-in-differences analysis
.
Lancet Glob Health
.
2019
;
7
(
9
):
e1189
96
.
74.
Boerekamps
A
,
van den Berk
GE
,
Lauw
FN
,
Leyten
EM
,
van Kasteren
ME
,
van Eeden
A
, et al
.
Declining hepatitis C virus (HCV) incidence in Dutch human immunodeficiency virus-positive men who have sex with men after unrestricted access to HCV therapy
.
Clin Infect Dis
.
2018
;
66
(
9
):
1360
5
.
75.
Martinello
M
,
Yee
J
,
Bartlett
SR
,
Read
P
,
Baker
D
,
Post
JJ
, et al
.
Moving towards hepatitis C microelimination among people living with human immunodeficiency virus in Australia: the CEASE study
.
Clin Infect Dis
.
2020
;
71
(
6
):
1502
10
.
76.
Ingiliz
P
,
Martin
TC
,
Rodger
A
,
Stellbrink
HJ
,
Mauss
S
,
Boesecke
C
, et al
.
HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe
.
J Hepatol
.
2017
;
66
(
2
):
282
7
.
77.
Martinello
M
,
Grebely
J
,
Petoumenos
K
,
Gane
E
,
Hellard
M
,
Shaw
D
, et al
.
HCV reinfection incidence among individuals treated for recent infection
.
J Viral Hepat
.
2017
;
24
(
5
):
359
70
.
78.
Platt
L
,
Minozzi
S
,
Reed
J
,
Vickerman
P
,
Hagan
H
,
French
C
, et al
.
Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs
.
Cochrane Database Syst Rev
.
2017
;
9
(
9
):
CD012021
.
79.
Larney
S
,
Peacock
A
,
Leung
J
,
Colledge
S
,
Hickman
M
,
Vickerman
P
, et al
.
Global, regional, and country-level coverage of interventions to prevent and manage HIV and hepatitis C among people who inject drugs: a systematic review
.
Lancet Glob Health
.
2017
;
5
(
12
):
e1208
20
.
80.
Younossi
Z
,
Papatheodoridis
G
,
Cacoub
P
,
Negro
F
,
Wedemeyer
H
,
Henry
L
, et al
.
The comprehensive outcomes of hepatitis C virus infection: a multi-faceted chronic disease
.
J Viral Hepat
.
2018
;
25
(
Suppl 3
):
6
14
.
81.
Kwon
JA
,
Dore
GJ
,
Hajarizadeh
B
,
Alavi
M
,
Valerio
H
,
Grebely
J
, et al
.
Australia could miss the WHO hepatitis C virus elimination targets due to declining treatment uptake and ongoing burden of advanced liver disease complications
.
PLoS One
.
2021
;
16
(
9
):
e0257369
.
82.
Boeke
CE
,
Adesigbin
C
,
Agwuocha
C
,
Anartati
A
,
Aung
HT
,
Aung
KS
, et al
.
Initial success from a public health approach to hepatitis C testing, treatment and cure in seven countries: the road to elimination
.
BMJ Glob Health
.
2020
;
5
(
12
):
e003767
.
83.
Blach
S
,
Brown
KA
,
Brown
RS
,
Gholam
PM
,
Terrault
NA
,
Estes
C
, et al
.
Modeling HCV elimination recovery following the COVID-19 pandemic in the United States: pathways to regain progress
.
J Infect Public Health
.
2023
;
16
(
1
):
64
70
.
84.
Crespo
J
,
Cabezas
J
,
Calleja
JL
,
Buti
M
,
Lazarus
JV
.
The path to successful hepatitis C elimination in Spain
.
Nat Rev Gastroenterol Hepatol
.
2023
;
20
(
11
):
689
90
.
85.
Sarrazin
C
,
Boesecke
C
,
Golsabahi-Broclawski
S
,
Moog
G
,
Negro
F
,
Silaidos
C
, et al
.
Hepatitis C virus: current steps toward elimination in Germany and barriers to reaching the 2030 goal
.
Health Sci Rep
.
2021
;
4
(
2
):
e290
.
86.
Kupcinskas
L
,
Ciupkeviciene
E
,
Voeller
A
,
Urbonas
G
,
Jancoriene
L
,
Liakina
V
, et al
.
Hepatitis C screening program in Lithuania: first results and scenarios for virus elimination
.
J Hepatol
.
2023
;
78
:
S912
3
.