Consensus-based Approaches for Hepatitis C Screening and Diagnosis in General and Vulnerable Populations

Hepatitis C screening and diagnosis are both pre-requisite to predicting infection endemicity, transmission risks and identifying vulnerable hepatitis C infected populations in highly endemic areas of the infection prevalence. It is also pivotal to select optimal treatment choices and their impact, including cost and access to care, especially in resource-constrained areas in an era of all oral interferon-free direct-acting antivirals. Furthermore, hepatitis C screening is also very crucial to “find the missing millions” to achieve the hepatitis C elimination goal by 2030. It seems only possible by implementing new screening and diagnostic approaches like RNA point-of-care (RNA POC) testing, rapid diagnostic tests (RDTs), and dried blood spot (DBS) sample testing, especially in remote communities having poor health infrastructure and where phlebotomies are a major concern for samples collection from patients who inject drugs (PWIDs). In addition to that, it is also very much required to bring HCV diagnostic facilities to decentralized healthcare centers which provide care for people at high risk or opportunistic infection of hepatitis C transmission by sexual contacts (e.g., men who have sex with men (MSM), sex workers, current or former IDUs, people who are incarcerated, and people in drug harm reduction centers). In this book chapter, we will discuss consensus-based recommendations and approaches for hepatitis C screening and diagnosis in general and vulnerable populations with their potential significance for the identification and diagnosis of high-risk individuals of hepatitis C transmission. We will also emphasize the importance of initial HCV screening before the start of HCV treatment.