Optimizing the HCV Care Continuum in Primary Care: Opportunistic Screening With Point‐Of‐Care RNA Testing and Immediate Linkage‐To‐Care in Rio de Ja

ABSTRACT

Optimizing the hepatitis C virus (HCV) care cascade is critical for elimination. We aimed to evaluate a nurse‐led opportunistic screening strategy integrated with point‐of‐care (POC) HCV‐RNA testing and immediate linkage‐to‐care in primary care. A cohort study was conducted across three Basic Health Units located in a low‐income region of Rio de Janeiro, Brazil. A simplified health team (nurse and laboratory technician) offered opportunistic HCV screening (HCV rapid‐test (RT), SD‐Bioline, Abbott) for adults (18–79 years) who were attending or using health services from July/2022 to June/2025. People with positive HCV‐RT were linked to care at a reference centre for POC HCV‐RNA confirmation (Xpert HCV Viral Load; Cepheid) and pan‐genotypic treatment (sofosbuvir/velpatasvir). Among 11,270 screened individuals [74.8% female, median age = 49 (IQR, 35–61), 24% unemployed], 0.78% ( n  = 88) tested antibody‐positive. Independent factors associated with positive HCV rapid test included higher age [aOR = 1.86 (95% CI, 1.52–2.27)], HIV infection [aOR = 13.68 (95% CI, 5.18–36.17)], and history of blood transfusion [aOR = 2.45 (95% CI, 1.60–3.76)]. Among 88 people with positive rapid HCV test, 80 (91%) completed POC‐HCV‐RNA testing, identifying 49 viraemic cases [prevalence = 0.43% (95% CI, 0.32–0.57)]. Treatment initiation occurred in 42/49 (86%) of viraemic participants and 90% ( n  = 38/42) returned to assess sustained virological response (SVR12), which was achieved in 38/42 (90% intention‐to‐treat; 100% per‐protocol). The median time from HCV screening to treatment initiation was 20 days (IQR, 14–28; range: 5–54). In conclusion, opportunistic decentralized testing by a nurse‐led team, coupled with collaboration with reference centres and POC‐RNA confirmation, optimizes the HCV care continuum in resource‐limited settings. This model could accelerate cure rates and support the WHO elimination goals.