Real‐World Impact of a Simplified ‘Test and Treat’ Strategy for In‐Hospital HCV Micro‐Elimination

Hepatitis C virus (HCV) micro-elimination faces challenges from fragmented care pathways, particularly in high-prevalence regions with complex genotypes and socioeconomic barriers. This study evaluated a simplified 'Test and Treat' (TNT) strategy to enhance in-hospital HCV micro-elimination by reducing delays and improving linkage to care. Outcomes including HCV RNA testing rates, treatment uptake rates, time to treatment initiation and sustained virological response at 12 weeks (SVR12) of Pre-TNT (Jan. 2022-Dec. 2022) and post-TNT (Jan. 2023-Dec. 2024) were compared. Following TNT implementation, among 168,527 screened patients, the HCV RNA testing rate increased to 93.96% (2070/2203) from 68.17% under pre-TNT, and the treatment rate among viremic patients rose to 81.98% (678/827) from 63.05%. The median time to treatment initiation was dramatically reduced from 12.5 to 3.8 days. SVR12 remained high, with a rate of 99.71%. Barriers among untreated patients were investigated via surveys and follow-ups. Surveys of 500 HCV antibody positive patients revealed limited affordability (only 5% could bear costs > ¥8000) and low health literacy (only 39% knew about prevention and treatment). Among 149 untreated viremic patients, financial constraints and the perception that treatment was unnecessary while asymptomatic were key refusal reasons. The in-hospital streamlined TNT strategy significantly improved HCV RNA testing linkage and treatment uptake, markedly reduced time to treatment initiation and achieved near-universal cure, surpassing WHO treatment targets. Its effectiveness supports broader adoption in high-prevalence regions, though complementary interventions addressing affordability and health literacy are needed for further progress.