The Consensus Hepatitis C Cascade of Care: Standardized Reporting to Monitor Progress Toward Elimination

Abstract

Cascade-of-care (CoC) monitoring is an important component of the response to the global hepatitis C virus (HCV) epidemic. CoC metrics can be used to communicate, in simple terms, the extent to which national and subnational governments are advancing on key targets, and CoC findings can inform strategic decision-making regarding how to maximize the progression of individuals with HCV to diagnosis, treatment, and cure. The value of reporting would be enhanced if a standardized approach were used for generating CoCs. We have described the Consensus HCV CoC that we developed to address this need and have presented findings from Denmark, Norway, and Sweden, where it was piloted. We encourage the uptake of the Consensus HCV CoC as a global instrument for facilitating clear and consistent reporting via the World Health Organization (WHO) viral hepatitis monitoring platform and for ensuring accurate monitoring of progress toward WHO's 2030 hepatitis C elimination targets.

The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services

“…Individuals were categorised as having reached one of four cascade stages at the end of the respective period; (1) diagnosed RNA-positive; (2) tested for HCV viral load or HCV genotype; (3) prescribed hepatitis C treatment within the clinical network; and (4) having evidence of cure. Cascade stages were adapted from the recently developed international Consensus Hepatitis C Cascade of Care, [16] with 'tested for HCV viral load or HCV genotype' reflecting linkage to hepatitis C care, a supplementary stage included in the Consensus Cascade. Individuals with an electronic prescription for hepatitis C treatment were assumed to be diagnosed RNA-positive and were included in cascade, even if no positive RNA test result or HCV viral/genotype test was recorded in patient management systems.…”

Loss to follow‐up in the hepatitis C care cascade: A substantial problem but opportunity for micro‐elimination

“…Suppl file [1][2][3][4][5][6][7][8][9][10][11] Some of these studies mention death separately and do not include this as a reason for LTFU. Suppl file [12][13][14][15][16][17] Other studies that reviewed ever-diagnosed patients defined LTFU as patients who never or not recently had an appointment with an HCV specialist. Suppl file 18,19 Interventional studies aiming to improve the cascade of care also do not give a definition or define LTFU as nonattendance anywhere in the care cascade, Suppl file often separating death from the LTFU group.…”

A micro-elimination approach to addressing hepatitis C in Turkey

“…In addition to the aforementioned barriers to improving HCV treatment access in Turkey, the lack of epidemiological data available in the country hinders proper reporting and surveillance efforts. One solution would be to simplify the cascade of care by using the consensus definition to standardize HCV reporting and monitor elimination effort progress across the country and in all sub-populations [38].…”