1 Barcelona Institute for Global Health (ISGlobal), Calle del Rossellón 132, 4th, ES-08036, Barcelona, Spain.
2 Infectious Diseases and Clinical Microbiology Territorial Direction, Translational Research Group on Infectious Diseases of Lleida (TRIDLE), Biomedical Research Institute Dr Pifarré Foundation, Av. Alcalde Rovira Roure 80, ES-25198, Lleida, Spain.
3 Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Japljeva 2, 1525, Ljubljana, Slovenia.
4 Médecins du Monde France, Paris, France.
5 Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana Japljeva 2, 1525, Ljubljana, Slovenia.
6 Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
7 Kirketon Road Centre, PO Box 22, Kings Cross, Sydney, NSW, 1340, Australia.
8 Division of Molecular and Clinical Medicine, Mail Box 12, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, United Kingdom.
Globally, some 71 million people are chronically infected with hepatitis C virus (HCV). Marginalised populations, particularly people who inject drugs (PWID), have low testing, linkage-to-care and treatment rates for HCV. Several models of care (MoCs) and service delivery interventions have the potential to improve outcomes across the HCV cascade of care, but much of the relevant research was carried out when interferon-based treatment was the standard of care. Often it was not practical to scale up these earlier models and interventions because the clinical care needs of patients taking interferon-based regimens imposed too much of a financial and human resource burden on health systems. Despite the adoption of highly effective, all-oral direct-acting antiviral (DAA) therapies in recent years, approaches to HCV testing and treatment have evolved slowly and often remain rooted in earlier paradigms. The effectiveness of DAAs allows for simpler approaches and has encouraged countries where the drugs are widely available to set their sights on the ambitious World Health Organization (WHO) HCV elimination targets. Since a large proportion of chronically HCV-infected people are not currently accessing treatment, there is an urgent need to identify and implement existing simplified MoCs that speak to specific populations' needs. This article aims to: 1) review the evidence on MoCs for HCV; and 2) distil the findings into recommendations for how stakeholders can simplify the path taken by chronically HCV-infected individuals from testing to cure and subsequent care and monitoring.