Achieving Hepatitis C Micro-Elimination in a High-Burden Province of Thailand: The Phetchabun Model
Wijitra Phaengkha, Pornjarim Nilyanimit, Nungruthai Suntronwong, Jiratchaya Puenpa, Duong Hoang Huy Le, Saranya Ngamnimit, Pattama Janpathip, Lapasrada Kamput, Kawin Thongnoi, Wanalee Toomta, Phatcha Wohanklong, Jarunlak Saokeaw, Niphapornt Thammajit, Suwannee Rerngleum, Ananyalak Yoisara, Nitiya Srisuk, Jidapa Suwannachat, Anchalee Karagate, Rujipat Wasitthankasem, Yong PoovorawanThe World Health Organization targets hepatitis C virus (HCV) elimination as a public-health threat by 2030. Phetchabun province, in lower northern Thailand, has historically reported one of the country’s highest HCV seroprevalence rates. We describe a province-wide, decentralized test-to-treat micro-elimination program implemented within Thailand’s universal health-coverage system. Adults aged 35–64 years (2020–2024) and individuals born before 1992 (late 2023) across all 11 districts were screened using fingerstick anti-HCV rapid diagnostic tests at sub-district health-promoting hospitals. Reactive participants underwent confirmatory HCV-RNA testing at three regional nodes. Eligible patients received pangenotypic sofosbuvir/velpatasvir for 12 weeks, with ribavirin added for cirrhosis. Sustained virological response at 12 weeks post-treatment (SVR12) was the primary outcome. Of 400,567 targeted individuals, 389,547 (97.3%) were screened; 18,340 (4.71%) were anti-HCV reactive. Confirmatory HCV-RNA testing was completed in 14,845 (80.9%), of whom 10,996 (74.1%) had active infection. Of 8961 treatment-eligible patients, 8842 (98.7%) received DAA therapy. Among 6719 evaluable for SVR12, 6474 (96.4%) achieved cure. This simplified, domestically financed, decentralized test-to-treat model achieved WHO-target-level diagnosis, treatment, and cure rates at provincial scale, offering a scalable framework for HCV micro-elimination in low- and middle-income countries.