{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T17:39:46Z","timestamp":1788716386600,"version":"build-2803163510"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T00:00:00Z","timestamp":1764201600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008196","name":"M\u00e9decins Sans Fronti\u00e8res","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Pakistan has the world's highest hepatitis C virus (HCV) prevalence, yet access to HCV care remains limited. In collaboration with the Ministry of Health Sindh, M\u00e9decins Sans Fronti\u00e8res implemented a simplified, decentralised model for HCV screening and treatment at a government\u2010run primary health centre (PHC) in Baldia Town, Karachi, Pakistan. This cohort study assessed treatment uptake, effectiveness, and retention among patients screened between August 2022 and July 2023. Individuals aged \u2265\u200912\u2009years were screened using capillary blood rapid diagnostic tests, with HCV viraemia confirmed via GeneXpert. Viraemic patients were treated with 12\u2010 or 24\u2010week regimens of sofosbuvir (400\u2009mg) and daclatasvir (60\u2009mg), depending on the fibrosis degree. Cure was defined as a sustained virological response (viral load &lt;\u200910\u2009IU\/mL) at 12\u2009weeks post\u2010treatment (SVR12). Among 3505 individuals screened, 613 (17.5%) tested HCV\u2010antibody positive. Of these, 610 received confirmatory viral load testing, revealing 225 (37.9%) HCV RNA positive. A total of 161 (71.6%) initiated treatment, with a median time of 5\u2009days (IQR 2\u20139) from diagnosis, while 23 (10.2%) were deemed ineligible and 41 (18.2%) lost to follow\u2010up. Of the 118 patients assessed for SVR12, 114 (96.6%) achieved cure. Overall, 91.3% of those who started treatment completed it. These findings demonstrate the effectiveness of decentralised, primary care\u2013based HCV management in a high\u2010burden, resource\u2010limited setting. The model appears feasible in terms of patient\u2010level outcomes, though broader operational feasibility\u2014including resources and scalability\u2014was not formally assessed. Remaining barriers to treatment initiation and follow\u2010up need to be addressed to advance national HCV elimination goals.<\/jats:p>","DOI":"10.1111\/jvh.70103","type":"journal-article","created":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T13:35:18Z","timestamp":1764250518000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Decentralised Hepatitis C Management: A Simplified, Integrated Model of Care in a Primary Health Centre in Pakistan, August 2022\u2013June 2023"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7989-0661","authenticated-orcid":false,"given":"Sara","family":"Mazzilli","sequence":"first","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels (MSF OCB)  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad K.","family":"Aslam","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels (MSF OCB)  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mubashir","family":"Ahmed","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels (MSF OCB)  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yves","family":"Wailly","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels (MSF OCB)  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Miazek","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels (MSF OCB)  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sana","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Rural Health Center  Baldia Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Ravji","sequence":"additional","affiliation":[{"name":"Government of Sindh Health Department  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William A.","family":"de Glanville","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Operational Centre Brussels (MSF OCB)  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Isaakidis","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit University of Ioannina School of Medicine  Ioannina Greece"},{"name":"M\u00e9decins Sans Fronti\u00e8res, Southern Africa Medical Unit (SAMU)  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,27]]},"reference":[{"key":"e_1_2_11_2_1","first-page":"1689","volume-title":"Global Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections","author":"World Health Organization","year":"2021"},{"key":"e_1_2_11_3_1","volume-title":"Global Health Sector Strategy on Viral Hepatitis 2016\u20132021. Towards Ending Viral Hepatitis","author":"World Health Organization","year":"2016"},{"key":"e_1_2_11_4_1","first-page":"15","volume-title":"Guidelines for the Care and Treatment of Persons DIAGNOSED With Chronic Hepatitis C Virus Infection","author":"World Health Organization","year":"2018"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(21)00012\u20101"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.11.004"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.07.006"},{"key":"e_1_2_11_8_1","unstructured":"World Health Organization \u201cGlobal Hepatitis Report 2024 \u201d(2024) https:\/\/www.who.int\/publications\/i\/item\/9789240091672."},{"key":"e_1_2_11_9_1","unstructured":"World Health Organization \u201cGlobal Hepatitis Report 2017 \u201d(2017) https:\/\/www.who.int\/publications\/i\/item\/9789241565455."},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0180286"},{"key":"e_1_2_11_11_1","unstructured":"WHO EMRO \u201cHealth Workforce Profile Pakistan \u201d(2020) https:\/\/rho.emro.who.int\/sites\/default\/files\/Profiles\u2010briefs\u2010files\/Pakistan\u2010HWF\u2010Snapshot.pdf."},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.35248\/2375-4273.19.07.244"},{"key":"e_1_2_11_13_1","unstructured":"The Hepatitis Found Decentralised Care in Punjab(2020) https:\/\/thehepatitisfund.org\/grant\/decentralized\u2010care\u2010in\u2010punjab\/?utm_source=chatgpt.com."},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jvh.13953"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics11081354"},{"key":"e_1_2_11_16_1","unstructured":"Coalition for Global Hepatitis Elimination \u201cPakistan HEAT Project. 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