Citation: Taha, G.; Ezra, L.; Abu-Freha, N. Hepatitis C Elimination: Opportunities and Challenges in 2023. Viruses 2023, 15, 1413. https://doi.org/10.3390/ v15071413 Academic Editor: Giordano Madeddu Received: 19 May 2023 Revised: 8 June 2023 Accepted: 20 June 2023 Published: 22 June 2023 Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). viruses Review Hepatitis C Elimination: Opportunities and Challenges in 2023 Gadeer Taha 1 , Levy Ezra 2 and Naim Abu-Freha 3,4, * 1 Department of Gastroenterology, Rambam Health Care Campus, Haifa 31096, Israel 2 Medical School for International Health, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel 3 Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel 4 Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 84105, Israel * Correspondence: abufreha@yahoo.de or naimaf@clalit.org.il; Tel.: +972-8-640-2251; Fax: +972-8-623-3083 Abstract: Hepatitis C Virus (HCV) infection is a leading etiology of liver cirrhosis and its associated complications, namely, decompensated cirrhosis. As such, hepatitis C potentially necessitates liver transplantation and may result in death. Recently, HCV treatment has evolved. Current HCV treatment is effective in curing HCV; some of the agents are pan-genotypic. Numerous countries have adopted an initiative to eliminate HCV. Achieving elimination poses many challenges; it requires improved availability and accessibility of pan-genotypic therapy. Barriers exist at the level of the collective healthcare system and at the level of the individual healthcare providers and patients. Therefore, organized national and local efforts are needed. Surmounting these barriers calls for interventions concerning screening, linkage to care, and treatment delivery. Pertinent barriers include inadequate availability of screening, ill-equipped laboratory testing before treatment, and insufficient access to treatment. Interventions should seek to decentralize laboratory testing and treatment provision, increase funding for resources and personnel, and spread awareness. Special consideration should be allocated to at-risk populations, such as intravenous drug users, refugees, and prisoners. Computerized medical filing and telemedicine have the potential to refine HCV management by enhancing detection, availability, accessibility, and cost-effectiveness. Keywords: hepatitis C; elimination; barriers; health system; provider; patients 1. Introduction Hepatitis C virus (HCV) persists as a serious health problem in many regions of the world. The prevalence of HCV has fallen dramatically since oral direct-acting antivirals (DAA) were introduced. However, according to the World Health Organization (WHO), the global prevalence of chronic HCV infection remains as high as 58 million, including 3.2 million cases in adolescents and children [1]. In addition, there are approximately 1.5 million new infections per year [1]. WHO estimated that in 2019, 290,000 people died of hepatitis C. Mortality was mostly a result of complication of the chronic disease with cirrhosis and hepatocellular carcinoma (HCC) [1]. Hepatitis C ranges in severity from a mild, acute illness to a long-term, chronic condition that can lead to serious liver complications, such as cirrhosis and liver cancer. Many people with hepatitis C do not have noticeable symptoms, especially in the early stages. Therefore, it is difficult to detect the infection without testing. During the last decade, diagnosis and treatment have been simplified. The old process included a lot of laboratory testing during the treatment, treatment with significant side effects, and a low rate of sustained virologic response (SVR) [1–4]. Direct-acting antiviral medications cure the infection in most cases, and the treatment with oral DAAs is highly effective with minimal adverse effects [2–4]. Chronic HCV infection involves a long-term inflammatory process. The inflammation leads to fibrosis, cirrhosis, and other complications. Treatment decreases the virus’s inflammatory process, which, in turn, diminishes the severity of fibrosis and the rate of complications. Various Viruses 2023, 15, 1413. https://doi.org/10.3390/v15071413 https://www.mdpi.com/journal/viruses