Objectives Highly effective direct‐acting antivirals (DAAs) for Hepatitis C treatment are largely inaccessible in sub‐Saharan Africa. Data on treatment feasibility and outcomes in clinical settings are limited. We assessed the feasibility of achieving a high (≥90%) cure rate with DAAs in six gastroenterology clinics in Cameroon. Methods Patients with chronic Hepatitis C virus (HCV) infection were treated for 12 or 24 weeks with ledipasvir/sofosbuvir, ledipasvir/sofosbuvir/ribavirin or sofosbuvir/ribavirin, depending on the stage of liver disease and HCV genotype. The cure rate was defined as the proportion of patients with a sustained virological response 12 weeks after treatment completion (SVR12) among all treatment completers. Results We identified 190 HCV RNA positive patients between September‐2017 and August‐2018, 161 (84.7%) of whom started treatment. 105 (65.2%) were female, median age was 61.3 years [IQR = 55.9–66.9] and 11 (6.8%) were HIV‐positive. Median plasma HCV RNA was 6.0 log10 IU/mL [IQR = 5.6–6.4]. HCV genotypes identified were 1 (34.8%), 2 (13.7%), 4 (50.9%), 1 and 4 (0.6%); 46 (28.6%) strains of 160 single‐genotype infections were non‐subtypeable. Of 158 treatment completers, 152 (96.2%, 95%CI = 91.9–98.6%) achieved SVR12. Six patients did not achieve SVR12: five carried HCV with NS5A resistance mutations and one with NS5B resistance mutations. Three patients died before and two after treatment completion. The most common adverse events were asthenia (12.0%), headache (11.4%) and dizziness (18.9%). Conclusion High cure rates of Hepatitis C with DAAs are achievable in clinical settings of Cameroon. However, the accessibility and provision of HCV screening, diagnosis, treatment, monitoring and care should be addressed for large‐scale implementation.

In the absence of sufficient (tax-based) healthcare financing in low-and middle-income countries, innovative financing models are needed. This study assessed quantitatively and qualitative the feasibility of a Development Impact Bond (DIB) for hepatitis C Virus (HCV) diagnosis and treatment in Cameroon. A revolving fund of up to EUR230,000 was made available by the investor. The outcome payor repaid the investor only in case of good performance, defined as cured patients (HCV-RNA negative). Identified HCV carriers were referred for treatment and tested for cure 12 weeks after completion of treatment, the outcome being validated by an independent party. The evaluation was guided by a recognized framework, involving interviews with relevant stakeholders (N= 22). In total, 253 (98%) patients completed treatment of which 244 (96%) are cured at week 24. We estimated that the average per patient outcome payment for HCV diagnosis and treatment is EUR1,542 and the average costs per treated patient is EUR1,858. The investor was fully repaid including the agreed interest and bonus rate. The interviews confirmed the feasibility of the DIB in a low-resource setting. This study demonstrates that a DIB can be a suitable financing mechanism for HCV services, supporting the path towards elimination. When governments do not have sufficient resources to fund such elimination programs upfront, such public-private partnerships can offer a solution.