Evaluating Hepatitis C cascade of care surveillance system in Tuscany, Italy, through a population retrospective data-linkage study, 2015-2021

Abstract

Abstract Worldwide, an estimated 57,8 million people are chronically infected with the hepatitis C virus (HCV), of which 3.9 million are in the European Union/Economic European Area (EU/EEA). The advent of direct-acting antivirals (DAA) has led to the target of eliminating HCV by 2030. In Tuscany (Italy), a triennial action plan was launched in 2018 aimed at increasing treatment coverage and contributing to the elimination of HCV in the three million population. This retrospective population study assesses the progress towards the HCV elimination goals from 2015 to 2021, through administrative healthcare records data linkage. 337,839 individuals were screened for HCV at least once by the regional health services in Tuscany, while the number of new diagnoses remained almost constant in the study period. A total of 12,980 patients started DAA treatment, increasing rapidly since 2015 and peaking at 3,610 in 2018, well below the regional target of 6xxx/year set for the period 2018–2020. COVID-19 pandemic, among other factors, slowed progress since 2020. Administrative healthcare records were useful to monitor HCV elimination progress in the absence of a dedicated surveillance system, however important data gaps remain. The national HCV elimination strategy and the corresponding regional plan were successful in streamlining specialized services for accessing DAA treatment in Tuscany. However, screening activities require strengthening to scale-up case identification and early diagnosis in the region.