Simplified Test-to-Treat Strategy for Hepatitis C in Thailand: The Phetchabun Model.

Abstract

The complexity of the hepatitis C virus (HCV) diagnostic workflow and stringent criteria for universal health coverage are significant barriers to achieving HCV elimination in Thailand. A test-to-treat strategy using a rapid diagnostic test (RDT) for screening at point of care, followed by a qualitative nucleic acid testing, is a promising strategy to facilitate population-wide screening for HCV infection and expedite time to treatment. This strategy was evaluated in Phetchabun province, Thailand, where the HCV burden is relatively high. This simplified HCV test-to-treat strategy showed strong potential to be implemented at a national level. Several obstacles to implementation included the stringent criteria for universal health coverage, which prioritizes patients with advanced disease, the continuous policy revision for HCV treatment and care, the relatively low public awareness of HCV infection, and the lagging of government policy prioritization. All of these contribute to the delayed progress in hepatitis elimination.