Hepatitis C virus genotype and viral testing, and on‐treatment monitoring: necessary or overkill?

In order to achieve the HCV elimination goal of the World Health Organization (WHO) by the year 2030, simplification of screening and diagnosis are essential. Several strategies have been developed to simplify screening and diagnosis of HCV infection. Rapid diagnostic tests (RDTs) have been developed as HCV antibody screening tests that offer advantage over classical enzyme immunoassay (EIA) techniques. New simplified diagnostic strategies such as HCV core antigen test (HCV cAg) and HCV RNA POC (point-of-care) test which can be used in decentralized settings are being evaluated to replace the traditional HCV RNA testing using nucleic acid amplification technologies (NAATs). One-step screening and diagnosis using these techniques could prove to be cost-effective through simplified algorithms. Further, with the advent of highly effective pan genotypic direct-acting antiviral (DAA) therapy, HCV genotype testing could eventually be eliminated, thus reducing the overall cost of diagnosis and care, especially in the low- and middle-income countries (LMICs). Further, post-treatment monitoring can be reduced to a single HCV RNA test at 12 or 24 weeks after treatment to assess cure. However, despite the advances in the newly developed screening and diagnostic tests, the overall "package" is still expensive and there is need for generalizable data that can be followed in specific patient populations. A simplified model of diagnosis and treatment algorithm may not be a fit for all the global regions, and for special populations, and more studies on cost-effectiveness of a simplified approach are required in different-country specific settings