Simplification of hepatitis C testing: a time to act.

Hepatitis C virus (HCV) affects 71 million people worldwide. The development of reliable diagnostic tools in the last 2 decades and recent implementation of highly potent and safe antiviral drug combinations have paved the way to potential elimination of HCV as a public health threat by 2030. This article briefly discusses current and upcoming solutions for simplification of HCV testing taking into account the most recent guidance documents issued by major professional societies. The general consensus is that all patients with suspected HCV infection should be tested for anti-HCV antibodies as a first-line diagnostic test. Some anti-HCV rapid diagnostic tests have already attained the performance of standard anti-HCV enzyme immunoassays. If anti-HCV antibodies are detected, the presence of HCV RNA or HCV core antigen should be determined to identify patients with ongoing infection. Several innovative devices for detecting HCV in serum or plasma are in the late stages of development and are based on loop-mediated isothermal amplification, smartphone-operated instruments, biosensors, lab-on-a-chip solutions, paper-based microfluidics, and CRISPR-Cas. An important solution for low- and middle-income countries is the availability of HCV tests that could perform equally reliably from whole blood and dried blood spots as well as from serum or plasma. Another interesting diagnostic concept for these countries is near-to-patient diagnostics using mobile microbiological laboratories, following either the lab-on-a-drone or rent-a-point-of-care-test concepts. Using current and upcoming diagnostic approaches, the elimination of HCV is plausible, but in several countries this is probably not possible within the timeframe suggested by the World Health Organization. Two different elimination approaches have already been successfully tested in real-life conditions: micro-elimination and macro-elimination. The micro-elimination approach has resulted in successful elimination in specific population subgroups in some high-income countries. In at least two countries, Georgia and Egypt, a macro-elimination approach has shown impressive real-life results relatively quickly.