Achieving Hepatitis C Micro-Elimination in a High-Burden Province of Thailand: The Phetchabun Model

The World Health Organization targets hepatitis C virus (HCV) elimination as a public-health threat by 2030. Phetchabun province, in lower northern Thailand, has historically reported one of the country's highest HCV seroprevalence rates. We describe a province-wide, decentralized test-to-treat micro-elimination program implemented within Thailand's universal health-coverage system. Adults aged 35-64 years (2020-2024) and individuals born before 1992 (late 2023) across all 11 districts were screened using fingerstick anti-HCV rapid diagnostic tests at sub-district health-promoting hospitals. Reactive participants underwent confirmatory HCV-RNA testing at three regional nodes. Eligible patients received pangenotypic sofosbuvir/velpatasvir for 12 weeks, with ribavirin added for cirrhosis. Sustained virological response at 12 weeks post-treatment (SVR12) was the primary outcome. Of 400,567 targeted individuals, 389,547 (97.3%) were screened; 18,340 (4.71%) were anti-HCV reactive. Confirmatory HCV-RNA testing was completed in 14,845 (80.9%), of whom 10,996 (74.1%) had active infection. Of 8961 treatment-eligible patients, 8842 (98.7%) received DAA therapy. Among 6719 evaluable for SVR12, 6474 (96.4%) achieved cure. This simplified, domestically financed, decentralized test-to-treat model achieved WHO-target-level diagnosis, treatment, and cure rates at provincial scale, offering a scalable framework for HCV micro-elimination in low- and middle-income countries.