Closing the hepatitis C diagnostic gap: Point-of-care testing, reflex RNA testing and simplified diagnosis

Abstract

Hepatitis C virus (HCV) infection remains a major public health challenge despite the availability of highly effective direct-acting antiviral therapies. A substantial barrier to elimination is the gap between initial screening, confirmation of active infection and linkage to treatment. Conventional diagnostic pathways commonly require an antibody test followed by nucleic acid testing (NAT) for HCV RNA, creating additional costs, delays and opportunities for loss to follow-up. Emerging approaches, including reflex RNA testing, point-of-care molecular assays, dried blood spot sampling, HCV core antigen detection and self-testing, offer opportunities to simplify diagnosis and extend testing to underserved populations. However, these approaches differ in analytical sensitivity, infrastructure requirements, cost and suitability across clinical settings. This mini-review examines the principal diagnostic barriers and emerging strategies for improving HCV case detection. It argues that diagnostic innovation must be accompanied by decentralised service delivery, quality assurance and effective linkage to care to accelerate progress towards HCV elimination.