Evaluating hepatitis C cascade of care surveillance system in Tuscany, Italy, through a population retrospective data-linkage study, 2015-2021

Abstract

This comprehensive retrospective data-linkage study aimed at evaluating the impact of Direct-Acting Antivirals (DAAs) on Hepatitis C Virus (HCV) testing, treatment trends, and access to care in Tuscany over six years following their introduction. Utilizing administrative healthcare records, our work reveals a substantial increase in HCV tests in 2017, attributed to the decision to provide universal access to treatment. However, despite efforts to eradicate chronic HCV through a government-led plan, the target of treating 6,221 patients annually was not met, and services contracted after 2018, exacerbated by the COVID-19 pandemic. Key findings indicate a higher prevalence of HCV screening among females in the 33-53 age group, influenced by pregnancy-related recommendations, while diagnostic tests and treatment uptake were more common among males. Problematic substance users constituted a significant proportion of those tested and treated, emphasizing their priority in HCV screening. Our paper underscores the need for decentralized HCV models and alternative testing strategies, such as point-of-care assays, especially in populations accessing harm reduction services, communities, and prisons. The study acknowledges limitations in relying solely on administrative records, advocating for improved data access and timely linkages to accurately monitor HCV care cascades and inform regional plans. Despite challenges, the paper demonstrates the value of administrative record linkages in understanding the access to care pathway for hard-to-reach populations. The findings emphasize the importance of the national HCV elimination strategy and the need for enhanced data collection to assess progress accurately, providing insights for future regional and national interventions.

Keywords: DAA treatment; Evidence-based policy making; HCV; HCV diagnosis; HCV screening; Linkage to care.

Fig. 1

Definition of the study cohort per year and the three priority groups

Fig. 2

Data linkage

Fig. 3

Individuals tested for HCV Ab by sex and age groups per 100,000 inhabitants, Tuscany, 2015–2021

Fig. 4

Number of DAA treatments initiated by sex, year of first prescription, and expected trend (dotted line) over time, Tuscany, 2015–2021; dotted line represents DAA treatments trend over the study period

Fig. 5

Annual percentage variation rate for HCV-Ab screening test (Anti-HCV), HCV diagnostic test (HCV RNA), and DAA treatment, Tuscany, 2015–2021