A New Model for Hepatitis C Elimination: CDC-Dispatching Follow-Up Coordinators Stationed in Hospitals

This study aimed to establish and evaluate a three-tiered closed-loop management model for hepatitis C involving 'CDC-community-follow-up coordinators', so as to improve the referral rate and DAA treatment rate for previously diagnosed but untreated (DBU) patients, enhance the diagnosis and treatment coverage for in-hospital HCV antibody-positive patients, and accelerate the elimination of hepatitis C. In April 2024, the novel 'CDC-community-stationed follow-up coordinators' model for hepatitis C management was launched in Nanhai District, Foshan City, with the CDC coordinating the recall of historical DBU patients; through government-procured third-party follow-up services, stationed follow-up coordinators were assigned to Nanhai District People's Hospital to facilitate the follow-up, diagnosis and treatment of both in-hospital patients and external DBU patients, while comparisons were conducted between pre- and post-implementation periods regarding HCV RNA testing rates, DAA treatment rates and diagnosis-to-treatment delays, and treatment adherence and completion rates across different populations were assessed. A total of 4975 DBU patients between 2004 and 2024 were identified from the CDC database, and after 3 months of telephone follow-up, the response rate was 38.21% (1901/4975), the recall rate 23.55% (401/1703), the HCV RNA positivity rate 25.69% (103/401), and the DAA treatment rate 54.4% (56/103). After the implementation of the model, the in-hospital HCV RNA testing rate for anti-HCV-positive patients increased from 68.1% (738/1084, January 2022-March 2024) to 90.97% (393/432, April-December 2024), and the DAA treatment rate rose from 43.1% (116/269, January 2022-March 2024) to 76.7% (92/120, April-December 2024); the mean time from antibody positivity to RNA testing decreased from 19.3 days to 11.0 days, and the time from diagnosis to treatment initiation shortened from 42.2 days to 22.6 days. The CDC-dispatching stationed follow-up coordinator model enables effective link-to-care for DBU patients and significantly improves the diagnosis and treatment rates of in-hospital HCV cases, demonstrating strong potential for scaling up in resource-limited settings.