ArticleJournal of global health2026
Innovative management of hepatitis C: implementation and outcomes of the 'SMART' model in a general hospital.
Article in Journal of global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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 χ 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.
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