Global cascade of care for chronic hepatitis C virus infection: A systematic review and meta-analysis

Mohammad T. Yousafzai, Sahar Bajis, Maryam Alavi, Jason Grebely, Gregory J. Dore, Behzad Hajarizadeh

Research output: Contribution to journalReview articlepeer-review

27 Citations (Scopus)


The World Health Organization 2030 targets for hepatitis C virus (HCV) elimination include diagnosing 90% of people with HCV and treating 80% of people diagnosed with HCV. This systematic review assessed reported data on the HCV care cascade in various countries and populations, with a focus on direct-acting antiviral (DAA) treatment uptake. Bibliographic databases and conference presentations were searched for studies reporting the HCV care cascade (DAA treatment uptake was a requirement) among the overall population with HCV or sub-populations at greater risk of HCV. Population-based studies, with participants representative of a city, province/state or country were eligible. Twenty eligible studies were included, reporting HCV care cascade in 28 populations/sub-populations from 11 countries. DAA treatment uptake at national levels was reported from Iceland (95%), Egypt (92%), Georgia (79%), Norway (18%) and Sweden (8%), and at sub-national levels from the Netherlands (52%), Canada (50%), the United States (29%) and Denmark (5%). Among people with HIV-HCV co-infection, DAA treatment uptake was 62% in Canada, 44% in the Netherlands, 21% in Switzerland and 18% in the United States. Among people who inject drugs, DAA treatment uptake was 50% in Georgia, 40% in Canada, 37% in Australia and 13% in the United States. Data among people experiencing homelessness were only available from the United States (treatment uptake: 12%–14%). We found no eligible study reporting HCV care cascade data in prisons. Relatively few countries reported HCV care cascade at the national level. DAA treatment uptake was widely varied across populations/sub-populations, with higher rates reported in recent years.

Original languageEnglish
Pages (from-to)1340-1354
Number of pages15
JournalJournal of Viral Hepatitis
Issue number10
Publication statusPublished - Oct 2021
Externally publishedYes


  • DAA
  • HCV
  • care cascade
  • direct-acting antivirals
  • therapy
  • treatment uptake


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