WGO
Definition: This guideline covers all stages of the Hepatitis C management pathway: screening, testing, diagnosis, referral, treatment, care, and follow-up of children and adults with, or exposed to, hepatitis C (HCV) infection. Through the concept of “cascades” WGO guidelines are applicable to differing resource environments, by providing a collection of related diagnostic and treatment options arranged hierarchically in terms of conditions and available resources. More widespread use of cascades in guidelines may also motivate research into the best options for resource-limited services. The high prevalence of HCV infection in Low and Middle Income Countries (LMICs) leads to a high health-resource and financial burden on already resource-constrained countries. The main risk factor for HCV in LMICs is unsafe therapeutic injections, due to poor practical application of universal infection control guidelines, including sterilization of equipment. The availability and quality of diagnostic tests for HCV infection makes screening extremely difficult even in high-risk populations, leading to inaccurate data collection and reporting. Similarly, the standardization and methodology of polymerase chain reaction (PCR) testing makes the option of “whom to treat” even more difficult. The natural history of HCV is also different in the High and LMICs due to specific risk factors such as alcohol use, addiction, intravenous drug use, coinfections, and superinfections. Other comorbidities and nutritional deficiencies also affect liver histology and progression of the disease.
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