A hospital-based micro-elimination strategy for hepatitis C in western China: a retrospective before-after study

Hepatitis C virus (HCV) infection remains a major public health burden in China, with low rates of diagnosis and treatment. Hospital-based "micro-elimination" strategies have been proposed to identify and link high-risk patients to care, but evidence from real-world implementations, particularly in western China, is limited. This study aimed to evaluate changes in HCV screening, diagnosis, and follow-up rates following the implementation of a hospital-based micro-elimination strategy at a tertiary hospital in western China.

This retrospective, uncontrolled before-after study was conducted at a single tertiary hospital in Xi'an, China. The study comprised a pre-intervention phase (October 2017-September 2020) and a post-intervention phase (October 2020-May 2022). Hospital inpatient and laboratory databases were used to identify patients with positive anti-HCV or HCV-RNA tests. The micro-elimination strategy included: (i) identification of three high-risk groups using retrospective and routine data retrieval; (ii) telephone follow-up and patient education; and (iii) educational lectures for non-specialist healthcare workers. Primary outcomes were changes in anti-HCV screening rates, HCV diagnostic confirmation rates (HCV-RNA testing among anti-HCV positive), and loss to follow-up rates. Secondary outcomes included healthcare worker knowledge scores. Comparisons between phases were made using chi-square tests and t-tests, with no adjustment for confounders. A p-value < 0.05 was considered statistically significant.

After the MES conducted, the rate of HCV screening and diagnosis were significantly improved, while the lost follow-up rate were markedly decreased compared with the previous three years (all P < 0.001). The results showed that patients, who were males, aged above 40, attended to gastroenterology, respiratory and critical care medicine, and neurology departments, has higher rate of HCV infection. Notably, disease education tours significantly improved the non-specialist healthcare workers' knowledge about HCV infection, policy awareness and preventive methods (all P < 0.001). In addition, 86.8% of high-risk patients demonstrated a strong willingness to accept further testing and start DAAs treatment after receiving follow-up and health education.

The implementation of this hospital-based micro-elimination strategy was associated with an observed increase in HCV screening and diagnosis rates and a decrease in loss to follow-up compared with the pre-intervention period. Although causality cannot be established due to the uncontrolled before-after design, these findings suggest that such a strategy is feasible, low-cost, and may be a valuable component of hospital-based HCV elimination efforts. Further controlled studies are needed to confirm its effectiveness.