Background Reliable real-world data on direct acting anti-retroviral (DAA) uptake and treatment outcomes are lacking for patients with hepatitis C virus (HCV) in Sub-Saharan Africa (SSA). This study provides data on HCV DAA-based treatment outcomes, mortality, loss-to-follow up, and associated factors among patients in Eritrea. Methodology: A multicenter retrospective observational cohort study was conducted in two tertiary hospitals in Asmara, Eritrea. A structured checklist was used to collect data from patients’ cards. Descriptive and inferential statistics used included means, medians, chi-squire, Kaplan–Meier estimates, and multivariate Cox proportional hazard models. Results Out of 238 patients enrolled in the study, 227 were initiated on treatment. 125 patients had viral load at 12 weeks EOT whereas 102 patients had no viral load at 12 weeks EOT. Out of these patients with HCV RNA data post EOT, 116 (92.8%) had SVR12. The prevalence of death and lost-to-follow up (LTFU) were (7.5%, 95% CI: 1.7–4.1) and 67 (28.1%, 95% CI: 22.3–33.9) and 1.1 (95%CI: 0.8–1.5) per 10,000 person days, respectively. Independent predictors of LTFU included the enrollment year (2020: aHR = 2.2, 95% CI: 1-4.7; p-value = 0.04); Hospital (Hospital B: aHR = 2.2, 95% CI: 1-4.7; p-value = 0.03) and the FIB-4 score (FIB-Score < 1.45: aHR = 3.7, 95% CI: 1.2–11.5; p-value = 0.02). Conclusion The SVR rates achieved in this cohort were high. However, high mortality, late presentation and suboptimal population screening/case finding were uncovered. These challenges can be addressed by test-and-treat programs that simultaneously prioritize programmatic screening, decentralization of care, and better patient tracking in the HCV care cascade.
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