Scaling up HCV screening program: a three-phase pattern in a regional health system

Despite effective treatments, achieving WHO targets for hepatitis C elimination by 2030 remains challenging due to an implementation gap driven by low screening uptake. In Italy, a national free screening programme was introduced in 2019, but the decentralised health system has resulted in heterogeneous regional strategies, highlighting the need for scalable approaches to expand screening. In Tuscany (Italy), HCV screening is delivered through a multi-channel model including general practitioners, pharmacies, NGOs, and local health units. However, uptake remained limited. In November 2025, an active invitation strategy (mailed letters) targeting birth cohorts 1969–1989 was introduced. This study examined changes in screening uptake following the introduction of active invitation. A pre–post analysis of regional administrative data (July 2025–April 2026) examined cumulative trends over time, sub-regional geographical variation, and the relative contribution of delivery channels. Four-week aggregated data (to smooth reporting delays) show a clear three-phase pattern. A low-uptake phase (July–early November) is followed by a sharp inflection point and rapid scale-up (mid-November–early January), with activity rising from approximately 650 tests to peaks exceeding 32,000. A consolidation phase (January–April) shows declining but sustained levels above baseline. The increase was largely driven by pharmacies, which grew from around 15% to over 80% of total tests on monthly basis. Trends were consistent across all sub-regional areas. Screening scale-up depends on the interaction among demand generation and service accessibility. Active outreach increases uptake, but expansion occurs where low-threshold access exists. Pharmacies, due to their proximity to the population and direct access, enabled rapid scale-up and sustained activity. Integrating active invitation with accessible delivery offers a scalable approach to restoring screening and accelerating HCV elimination.

Key messages

• Combining active invitation with easy access rapidly scaled up HCV screening. Pharmacies absorbed most demand, turning outreach into sustained uptake.

• HCV screening showed a three-phase pattern after intervention. Scaling up depends on pairing demand generation with accessible services, not outreach alone.