Phetchabun’s micro-elimination programme linked fingerstick anti-HCV testing, HCV-RNA confirmation, and 12-week sofosbuvir/velpatasvir treatment through primary-care and district-hospital services across all 11 districts under universal health coverage. From 2020 to April 2026, 389,547 of 400,567 targeted people were screened (97.25%); 14,845 of 18,340 anti-HCV-reactive participants received RNA confirmation (80.94%), identifying 10,996 active infections. Of 8,961 treatment-eligible patients, 8,842 received therapy (98.67%); among 6,719 evaluated at SVR12, 6,474 were cured (96.35%). The programme demonstrates province-scale test-to-treat feasibility, but not yet the incidence or mortality reductions required for elimination.
Key findings
- The programme screened 389,547 of 400,567 targeted people (97.25%) across all 11 districts and found 18,340 anti-HCV-reactive participants (4.71% of those screened), with higher seroreactivity in northern districts.
- RNA confirmation was completed for 14,845 of 18,340 reactive participants (80.94%), leaving 3,495 without a confirmatory result in the cascade. Of those tested, 10,996 (74.07%) had active infection.
- DAA therapy reached 8,842 of 8,961 eligible patients (98.67%). Among 6,719 who completed treatment and underwent SVR12 assessment, 6,474 were cured (96.35%) and 245 failed. That cure rate uses evaluable patients as the denominator, not everyone treated.
- In a 444-patient sub-cohort, failure was associated in bivariate analyses with male sex, comorbidity, cirrhosis, injecting drug use, and irregular adherence. The non-random sub-cohort represented only 5.0% of province-wide recipients and no multivariable analysis was performed, so these are not independent predictors.
Why this matters globally
Phetchabun shows how a middle-income health system can combine active case-finding, RNA confirmation, pangenotypic treatment, district-level task-shifting, and UHC reimbursement data without external donor dependence. Transferable elements are a simplified workflow, free treatment, decentralization, and geographically defined cascade monitoring. Expansion elsewhere must adapt to prevalence, risk populations, mobility, RNA-laboratory capacity, medicine financing, and data systems, and must measure incidence, reinfection, liver cancer, mortality, and cost-effectiveness before claiming elimination.
Thai researcher contribution
The study arises from a Thai network spanning provincial hospitals and public-health authorities, Chulalongkorn University’s clinical-virology centre, NSTDA, and the Royal Society of Thailand. Wijitra Phaengkha and Pornjarim Nilyanimit contributed equally, and Yong Poovorawan is corresponding author. Publisher CRediT assigns conceptualization to Yong, Wijitra, Pornjarim, Nungruthai Suntronwong, and Jiratchaya Puenpa; sample and data collection to 13 provincial-service authors; methodology to Pornjarim, Nungruthai, and Saranya Ngamnimit; formal analysis to Pornjarim, Nungruthai, and Duong Hoang Huy Le; and writing/editing to Pornjarim, Nungruthai, Jiratchaya, Duong, Rujipat Wasitthankasem, and Yong. Thai services therefore co-produced the evidence from field implementation through policy and analysis.
Limitations to consider
Population mobility and cross-border migration can erode a province-limited strategy without coordination beyond Phetchabun. Residual transmission may persist among people who inject drugs, incarcerated people, haemodialysis patients, and people living with HIV. Pre-2022 eligibility prioritized advanced fibrosis and later criteria were liberalized, so the cohort spans changing policies and diagnostic workflows. Treatment-failure analysis used a non-random 444-patient sub-cohort, lacked multivariable adjustment and HIV/HBV status, while only aggregate data were available for confirmation, treatment uptake, and loss to follow-up. Cost-effectiveness, reinfection surveillance, and long-term incidence, liver-cancer, and mortality effects remain unmeasured, and the 96.35% SVR12 estimate does not cover all 8,842 treated patients.