Integrating HCV Testing and Treatment Into HIV Care: A Cohort Study of the HCV Care Cascade in Southwest China

Abstract

Aim

Within the global population living with human immunodeficiency virus (HIV), achieving hepatitis C virus (HCV) micro-elimination is a crucial public health strategy. We assessed the HCV care continuum among people with HIV (PWH) in Yunnan Province, China, a region with a historically high burden of both infections.

Methods

Linked data from provincial HIV and HCV surveillance systems (January 2022–June 2025) were analysed. An eight-stage care continuum was constructed, ranging from anti-HCV testing to sustained virologic response. Annual trends in the HCV care cascade were evaluated.

Results

Among 143 959 PWH, 90.3% underwent anti-HCV testing. Of the 20 627 individuals who tested anti-HCV positive, 67.3% were referred to the national surveillance system; among those reported, 84.7% tested positive for HCV RNA. Among individuals who were HCV RNA positive, 85.0% initiated direct-acting antiviral treatment; the rate was 87.7% among those who were alive and retained in care. Those who completed post-treatment assessment demonstrated a sustained virologic response rate of 99.1%. Between January 2022 and June 2025, the HCV RNA positivity rate among reported cases increased from 44.6% to 84.7%, with treatment initiation increasing from 77.5% to 85.0%. Subgroup analyses identified lower testing and treatment uptake among individuals lost to follow-up, those who died, and certain demographics such as older adults and farmers.

Conclusions

Yunnan has made significant strides toward HCV micro-elimination among PWH, demonstrating the feasibility of integrating HCV services into existing HIV care platforms. The findings may be useful to other resource-limited settings seeking to achieve elimination targets established by the World Health Organization.