Rapid Hepatitis C Virus Diagnostics: Aligning Molecular Innovation With Real-world Elimination Needs

To The Editor—We read with great interest the article by Reed et al describing the development of a rapid, point-of-care reverse transcriptase-polymerase chain reaction (RT-PCR) assay for hepatitis C virus (HCV) ribonucleic acid (RNA) on the diagnostic analyzer for selective hybridization (DASH) platform. The authors are to be congratulated for an important technical achievement, demonstrating detection with a time to result of approximately 15 minutes and agreement with established laboratory-based assays. The study addresses a well-recognized gap in the HCV cascade of care, namely delays introduced by centralized molecular confirmation of viremic infection. By substantially shortening PCR turnaround time, the DASH system represents a meaningful advance and may help reduce loss to follow-up in selected decentralized clinical settings [1]. Nevertheless, beyond analytical performance, cost and programmatic feasibility remain critical determinants of impact, particularly in low- and middle-income countries (LMICs), where the majority of the global HCV burden resides. While the per-test cost of the DASH assay is likely to be lower than conventional laboratory PCR, the cumulative expense of cartridges, dedicated analyzers, maintenance, and supply-chain requirements may still represent a significant barrier for large-scale deployment. Even relatively modest per-test costs can become prohibitive when applied to population-level screening, potentially limiting suitability for first-line case finding in resource-constrained settings.