National population based hepatitis c screening and elimination programme in Lithuania: what results: have we achieved?

Background: In Lithuania National HCV screening program started in May, 2022. General practitioners (GPs) received special promoting fee for serological HCV antibody testing: 1. For people born between 1945 and 1994 (once in a lifetime) and 2. For people who inject drugs (PWID) or HIV-positive people (annual testing). This initiative is the first in Central and Eastern Europe. The aim of this study was to assess the results of the first 34 months of the programme and evaluate the different scenarios for achieving the WHO 2030 targets. Methods: GPs invited people to perform a serum blood test for HCV antibodies. Anti-HCV+ patients were referred to a gastroenterologist or infectologist for HCV RNA testing, and if result was positive, direct-acting antiviral (DAA) therapy was prescribed. Information about patients was obtained from the National Health Insurance Fund. The Markov disease progression model elaborated by the CDA Foundation was used to assess HCV elimination progress. The data from the 2022-2023 screening were used as inputs. Three scenarios were developed: the ‘Base’ scenario - return to pre-screening program level in 2023 and 2 scenarios with different extents of treatment. Results: At the beginning of 2022, about 1.8 million people born in 1945-1994 lived in Lithuania. Between May 5, 2022 and February 28, 2025, from this population 1362472 people (75.7%) were tested for HCV antibodies. AntiHCV+ were found in 1.28% of cases. In the risk group, 8396 PWID and/or HIV+ people were screened, of whom 28.9 % were seropositive. Among anti-HCV+ persons 83.8% was from population and 16.2 % from risk groups. Specialists consulted 58% anti-HCV+ persons and viremia was detected in 53,1 %. Among anti-HCV+ persons from population specialist consulted 63%, but only 29% from risk group (p < 0.001). During 34-month (May 2022- February 2025) period 3 times more HCV patients were treated with DAA than during the same period before starting of the program (7577 vs 2470). The Markov disease progression model to assess HCV elimination progress showed the following scenarios: Scenario 1: if the same number of patients are treated as before the screening, the WHO targets will not be reached. Scenario 2: treating 70% of infected patients will meet most but not all WHO targets. Scenario 3: by treating all infected patients by 2030, the WHO target will be met by saving 150 lives and preventing 90 new cases of decompensated cirrhosis and 120 cases of hepatocellular carcinoma. Conclusion: In a European country with a moderate HCV seroprevalence, a population-based screening program is feasible and the number of patients treated has increased more than 3-fold in the first 34 months. Current status of the program predict that till 2030 country will meet most but not all WHO targets (the second scenario). Special measures to increase motivation and compliance of risk group patients to program logistic are necessary to achieve all WHO 2030 targets in Lithuania.