In a recent discussion, Andrew Aronsohn, MD, associate professor of Medicine at the University of Chicago Medical Center, highlights the need for a streamlined, one-visit “screen and treat” approach to improve care for patients with hepatitis C (HCV)—especially those from vulnerable populations. These patients often face barriers such as homelessness, substance use, and difficulty navigating complex health systems. Dr. Aronsohn emphasizes that each additional step in care increases the risk of losing patients to follow up. To address this, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) have developed an algorithm that enables clinicians to test and initiate HCV treatment during a single visit—an approach supported by evidence from both HCV and human immunodeficiency virus care models.

This updated algorithm outlines specific actions to be taken during the visit: point-of-care HCV RNA testing for rapid diagnosis, immediate medication dispensing for those who test positive, hepatitis B testing, and follow-up HCV RNA testing four weeks after completing therapy to confirm viral clearance. While the model isn’t suitable for every patient, it offers an important tool for clinicians treating high-risk groups. Dr. Aronsohn, who co-chairs the AASLD/IDSA HCV panel, notes that the algorithm is regularly updated to reflect new treatments and populations. Ultimately, the goal is to simplify the care process and increase the number of people cured of a disease that remains deadly despite being highly treatable.

Reference: Parkinson J, Aronsohn A. AASLD/IDSA Develop a New Algorithm for Hepatitis C Point of Care Testing and Treatment. Contagion. Published April 3, 2025. Accessed June 9, 2025. https://www.contagionlive.com/view/aasld-idsa-develop-a-new-algorithm-for-hepatitis-c-point-of-care-testing-and-treatment

Recent advances in hepatitis C virus (HCV) care have prompted a shift toward earlier screening and treatment for pregnant persons and children. Despite the known risk of vertical transmission and the availability of curative treatment for children as young as three, screening rates among infants exposed to HCV in utero remain low in Canada. To address this, major US organizations including the Centers for Disease Control and Prevention, American Association for the Study of Liver Diseases, and Infectious Disease Society of America now recommend HCV RNA testing at 2 to 6 months of age—rather than the traditional 18-month antibody test—to improve diagnosis and linkage to care. While Canada currently lacks updated national guidelines, the data strongly support earlier infant testing and integration into standard pediatric care, such as the Rourke Baby Record, to prevent missed diagnoses and long-term complications.

Universal HCV screening in pregnancy is also gaining traction as a key intervention. With rising HCV prevalence among people of childbearing age and vertical transmission rates of 5% to 6%, pregnancy offers a critical opportunity to diagnose and plan for postpartum treatment. Emerging research suggests treatment during pregnancy may be both safe and effective, leading to updated US recommendations for case-by-case consideration. Together, these shifts support a more proactive, prevention-focused approach to HCV elimination in Canada—one that prioritizes early screening, timely treatment, and reduced stigma for mothers and children alike.

Reference: Biondi MJ, Flemming J, van Gennip J, et al. Hepatitis C virus testing in infants: a move to early screening by HCV RNA at 2 months of age. Paediatr Child Health. 2025;pxaf012. doi:10.1093/pch/pxaf012.

Despite the availability of effective direct-acting antivirals (DAAs), hepatitis C virus (HCV) remains a global health threat, with high-income countries falling short of the World Health Organization's (WHO) 2030 goals to reduce new chronic hepatitis C infections by 80% and related deaths by 65%. The COVID-19 pandemic further disrupted screening and treatment efforts. Using Ontario, Canada, as a model, researchers simulated various intervention strategies—aggressive treatment, expanded screening, and enhanced harm reduction—to evaluate their impact on HCV incidence, prevalence, and liver-related outcomes through 2030. The model accounted for key factors often overlooked in past studies, including immigration, transmission networks, and pandemic-related healthcare disruptions.

Findings showed that while aggressive screening and treatment strategies significantly reduce CHC prevalence and liver-related complications, they fall short of achieving the WHO’s target for incidence reduction. Only the enhanced harm-reduction strategy—aimed at curbing transmission among people who inject drugs—reduced acute HCV incidence by over 80%. All strategies improved liver-related outcomes, with aggressive screening and treatment reducing liver-related deaths by nearly 73%. Sensitivity analyses highlighted the importance of targeting transmission dynamics and high-risk populations. The results suggest that comprehensive strategies, including robust prevention efforts, are essential to meet global HCV elimination goals.

Reference: Tian F, Forouzannia F, Feng Z, et al. Feasibility of hepatitis C elimination by screening and treatment alone in high-income countries. Hepatology. 2024;80(2):440-450. doi: 10.1097/HEP.0000000000000779.