Decentralised Hepatitis C Management: A Simplified, Integrated Model of Care in a Primary Health Centre in Pakistan, August 2022–June 2023

ABSTRACT Pakistan has the world's highest hepatitis C virus (HCV) prevalence, yet access to HCV care remains limited. In collaboration with the Ministry of Health Sindh, Médecins Sans Frontières implemented a simplified, decentralised model for HCV screening and treatment at a government‐run primary health centre (PHC) in Baldia Town, Karachi, Pakistan. This cohort study assessed treatment uptake, effectiveness, and retention among patients screened between August 2022 and July 2023. Individuals aged ≥ 12 years were screened using capillary blood rapid diagnostic tests, with HCV viraemia confirmed via GeneXpert. Viraemic patients were treated with 12‐ or 24‐week regimens of sofosbuvir (400 mg) and daclatasvir (60 mg), depending on the fibrosis degree. Cure was defined as a sustained virological response (viral load < 10 IU/mL) at 12 weeks post‐treatment (SVR12). Among 3505 individuals screened, 613 (17.5%) tested HCV‐antibody positive. Of these, 610 received confirmatory viral load testing, revealing 225 (37.9%) HCV RNA positive. A total of 161 (71.6%) initiated treatment, with a median time of 5 days (IQR 2–9) from diagnosis, while 23 (10.2%) were deemed ineligible and 41 (18.2%) lost to follow‐up. Of the 118 patients assessed for SVR12, 114 (96.6%) achieved cure. Overall, 91.3% of those who started treatment completed it. These findings demonstrate the effectiveness of decentralised, primary care–based HCV management in a high‐burden, resource‐limited setting. The model appears feasible in terms of patient‐level outcomes, though broader operational feasibility—including resources and scalability—was not formally assessed. Remaining barriers to treatment initiation and follow‐up need to be addressed to advance national HCV elimination goals.