Innovative management of hepatitis C: implementation and outcomes of the 'SMART' model in a general hospital.

BACKGROUND: This study aimed to evaluate the implementation and outcomes of the hepatitis C (HCV) SMART management model in a tertiary hospital, to provide insights for optimising HCV management globally. METHODS: A multidisciplinary HCV working group was established at The Second Xiangya Hospital to implement an in-hospital micro-elimination strategy. Based on post-implementation analysis, the SMART Model was enhanced in July 2022 with improved HCV education, a 'one-step' reflexive nucleic acid testing protocol, and dedicated follow-up specialists. We conducted a retrospective analysis of patients undergoing HCV antibody and RNA testing (January 2020-December 2023), comparing three periods: the Pre-Implementation, Micro-Elimination Model, and SMART Model periods. We analysed HCV RNA testing rates and direct-acting antiviral (DAA) treatment rates using χ2 tests and multivariable generalised estimating equations (GEE) to account for department-level clustering. RESULTS: A total of 355,191 patients were screened, with 4,355 (1.23%) testing anti-HCV-positive. Males and patients born before 1997 had significantly higher positivity rates. Blood-borne transmission was the predominant risk factor in the pre-1997 cohort. The Micro-Elimination Model increased the HCV RNA testing rate (53.76% vs. 58.33%, P = 0.014) but not the DAA treatment rate (65.33% vs. 64.21%, P = 0.780). In contrast, the SMART Model significantly improved both outcomes: the RNA testing rate rose to 77.10% (P < 0.001) and the DAA treatment rate to 71.29% (P = 0.044). Multivariable GEE analysis identified age <60 years, care in the Department of Infectious Diseases, and the SMART Model as positive independent predictors for both HCV RNA testing and DAA treatment initiation. CONCLUSIONS: The SMART Model significantly enhanced HCV diagnosis and treatment rates while improving clinical management. Future efforts should focus on disseminating this model to optimise healthcare resources and strategies.