Feasibility, effectiveness and cost of a decentralized HCV care model among the general population in Delhi, India

Liver Int. 2022 Mar;42(3):532-540. doi: 10.1111/liv.15112. Epub 2021 Nov 29.


Background and aims: India has a significant burden of hepatitis C virus (HCV) infection and has committed to achieving national elimination by 2030. This will require a substantial scale-up in testing and treatment. The "HEAD-Start Project Delhi" aimed to enhance HCV diagnosis and treatment pathways among the general population.

Methods: A prospective study was conducted at 5 district hospitals (Arm 1: one-stop shop), 15 polyclinics (Arm 2: referral for viral load (VL) testing and treatment) and 62 screening camps (Arm 3: referral for treatment). HCV prevalence, retention in the HCV care cascade, and turn-around time were measured.

Results: Between January and September 2019, 37 425 participants were screened for HCV. The median (IQR) age of participants was 35 (26-48) years, with 50.4% male and 49.6% female. A significantly higher proportion of participants in Arm 1 (93.7%) and Arm 3 (90.3%) received a VL test compared with Arm 2 (52.5%, P < .001). Of those confirmed positive, treatment was initiated at significantly higher rates for participants in both Arms 1 (85.6%) and 2 (73.7%) compared to Arm 3 (41.8%, P < .001). Arm 1 was found to be a cost-saving strategy compared to Arm 2, Arm 3, and no action.

Conclusions: Delivery of all services at a single site (district hospitals) resulted in a higher yield of HCV seropositive cases and retention compared with sites where participants were referred elsewhere for VL testing and/or treatment. The highest level of retention in the care cascade was also associated with the shortest turn-around times.

Keywords: India; decentralization; hepatitis C; primary health care; simplification.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Feasibility Studies
  • Female
  • Hepacivirus*
  • Hepatitis C* / diagnosis
  • Hepatitis C* / epidemiology
  • Hepatitis C* / therapy
  • Humans
  • India / epidemiology
  • Male
  • Middle Aged
  • Prospective Studies