[Hepatitis C Care Cascade Analysis: Assessing the Gaps in the Pathway from Screening to Treatment]

Although hepatitis C virus (HCV) infection is a curable disease with effective treatments today, gaps in the diagnostic and treatment steps remain the biggest obstacle to elimination. This study aimed to analyze the care cascade of the patients detected as positive for anti-HCV, determine linkage-to-care rates for confirmatory testing (HCV-RNA) and treatment and evaluate the attainability of microelimination targets at the provincial level.This retrospective, cross-sectional study included individuals tested for anti-HCV across all healthcare institutions in Ordu province between January 1, 2021 and December 31, 2024. Data were obtained from the Provincial Directorate of Health and a tertiary referral center and cross-analyzed. Rates of confirmatory HCV-RNA testing, viremia, treatment initiation and lost to follow-up at each step of the cascade of care were evaluated. Over the four-year period, 225.218 individuals were screened (29.2% of the provincial population) and anti-HCV seroprevalence was found to be 0.55% (n= 1241). The majority of test requests were made by surgical departments (38%) and family medicine units (26%). It was determined that only 47.5% (n= 590) of anti-HCV positive patients underwent HCV-RNA confirmatory testing; the remaining 52.5% (n= 651) were lost to follow-up in the diagnostic process. Viremia was detected in 17.2% (n=102) of the patients who underwent HCV-RNA testing. It was found that 69.6% (n= 71) of viremic patients initiated treatment, while 15.7% (n= 16) could not access treatment despite receiving a diagnosis. This study presented a comprehensive, population-based province-level HCV care cascade for the first time in Türkiye. The results demonstrate that insufficient linkage-to-care, resulting in substantial loss to follow-up during diagnostic and treatment stages, represents the primary barrier to HCV elimination. To achieve World Health Organization 2030 goals, micro-elimination strategies such as reflex testing implementation, automated alerts integrated into hospital information systems and active recall of patients lost to follow-up must be implemented.