Progress Towards Eliminating Hepatitis C as a Public Health Threat in Norway

The World Health Organisation aims to eliminate hepatitis C virus (HCV) infection as a public health threat by 2030. We assessed progress towards HCV elimination in Norway until the end of 2024. We used linked national registry data to describe diagnosed cases of HCV infection by treatment uptake and case characteristics, and the incidence of HCV-related death. We updated a stochastic compartmental model to estimate HCV incidence and prevalence among people who inject drugs and migrants. We summarised all available data to assess progress towards HCV elimination targets. Among 12,620 HCV RNA-positive cases still living in Norway in 2024, 10,824 (86%) had been treated. Among people who inject drugs the estimated incidence was 20 (95% credible interval (CrI): 8-39) new infections, or 0.3 per 100 (95% CrI: 0.1-0.5), and the estimated prevalence was 1498 (95% Crl, 549-3631) chronic infections in 2024. Among migrants, prevalence increased from 598 (95% CrI: 179-1156) in 2021 to 2228 (95% CrI: 1394-3071) in 2024. HCV-related deaths plateaued at 0.6-0.8 per 100,000 from 2017-2024. Norway achieved global targets for HCV incidence, mortality, treatment uptake, harm reduction and (likely) blood safety. There is a lack of data on the target for diagnostic coverage. We conclude that Norway has entered a new phase of the HCV epidemic, with low incidence of new infections, low mortality, and with prevalence becoming more influenced by patterns of migration. Further decentralisation and integration of testing and treatment are necessary to reach new national goals.