Optimizing the HCV Care Continuum in Primary Care: Opportunistic Screening With Point-Of-Care RNA Testing and Immediate Linkage-To-Care in Rio de Janeiro, Brazil

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.