Abstract / Summary
Chronic hepatitis C virus (HCV) infection affects an estimated 56.8 million people globally, resulting in chronic liver disease and a significant economic burden. The World Health Organization (WHO) aims to eliminate HCV by 2030, targeting a 65% reduction in deaths, 80% reduction in new infections, and diagnosis of over 90% of infected individuals. This is challenging for lower- and middle-income countries (LMICS) like India, where HCV viremia prevalence rate is 0.5%, affecting 4.7 to 10.9 million people. The elimination target is affected less by clinical efficacy than by real-world implementation challenges. This narrative review synthesizes through structured search, the evidence to analyse the determinants, strategies, and outcomes of HCV elimination in LMICs, focusing on India. Literature was searched using Google Scholar, PubMed and Scopus for studies related to HCV on treatment, elimination, public health programs and elimination strategies, and challenges in LMICs (January 2015 - September 2025). Multiple implementation determinants were identified at the patient/community, service-delivery, technological, and system/policy levels of care through identified 32 key references. Key challenges include insufficient screening strategies and the asymptomatic nature of the illness. Challenges include limited decentralized detection and treatment and, centralized care with limited nucleic acid amplification tests in the public health system, rural areas resource shortage, high directly acting antivirals (DAAs) medication costs, blood safety issues, inadequate infection control, and limited systemic resources. Additional challenges include antiviral resistance patterns, the absence of prophylactic vaccines, and surveillance gaps in the literature. Scalable implementation strategies include active screening with rapid diagnostic tests, decentralized care through task shifting, telemedicine, integration with existing programmes related to AIDS and TB, OST and prison health programmes, resistance surveillance, improving DAA accessibility through government funding and generic alternatives, capacity building and enhanced blood safety. Implementation outcomes reported across the models include feasibility, acceptability, reach among key populations and per cure cost, with the decentralised and integrated models achieving cure rates comparable to specialist care at a lower cost. This review highlights implementation determinants and strategies such as decentralized, care models, point-of-care (POC) diagnostics, public health programmes integration, strong political will, sustained funding, and multi-sectoral efforts. Meeting WHO 2030 targets requires scaling up POC testing for diagnostic targets, generic DAA procurement for treatment coverage, and the expansion of specialized care network.