Service readiness of Public and private health facilities for roll-out of hepatitis C screening and management: a cross-sectional study

TL;DR

This study evaluates the readiness of public and private health facilities in Pakistan to provide hepatitis C screening and treatment, finding significant gaps in both sectors.

Contribution

The study provides a comparative analysis of service readiness in public and private health facilities for hepatitis C management in Pakistan.

Findings

Public hospitals were more likely to offer DAA therapy and standardized guidelines, but faced resource shortages and paper-based systems.

Private facilities showed better equipment maintenance and electronic reporting but lacked integration with case notification and guidelines.

Both sectors had low awareness of community referral campaigns, highlighting a need for improved outreach and coordination.

Abstract

Direct-acting antiviral (DAA) therapy has transformed hepatitis C management by enabling cost-effective outpatient treatment. Pakistan, with one of the world’s highest hepatitis C burdens, has set ambitious policy targets for the rollout of DAA therapy supported by rapid screening and confirmatory testing. This study assessed the service readiness of public and private healthcare facilities to inform future scale-up of hepatitis C services in Pakistan.

Between June 2021 and January 2022, a purposive sample of 39 facilities was selected from 14 high-burden districts in consultation with the National Hepatitis Program: 15 public hospitals, 15 private hospitals, 6 standalone private laboratories, and 3 private blood banks. A cross-sectional descriptive assessment was conducted to evaluate service availability, commodity stocks, staff training, quality-of-care guidelines, reporting mechanisms, supervision, and community engagement. Data were collected through structured questionnaires administered to facility managers and staff, supplemented by an observation checklist.

DAA therapy was available at 10/15 (66.7%) public hospitals and 13/15 (86.7%) private hospitals. HCV screening was offered at 9/15 (60.0%) public hospitals compared to 3/15 (20.0%) private hospitals, with most private hospitals referring patients to standalone laboratories. Case notification was reported by 6/15 (40.0%) public facilities and 4/15 (26.7%) private facilities. In the public sector, DAA stock was available at 7/15 (46.7%) hospitals, but 5/10 (50.0%) of those offering treatment reported recent stock-outs. Private facilities generally prescribed DAAs from external pharmacies. Private laboratories had stronger systems for equipment calibration (4/5, 80.0%) and electronic reporting (5/6, 83.3%), while public facilities were more often supported with standardized guidelines (10/15, 66.7%). Awareness of community referral campaigns remained low in both sectors (≈20–25%).

This study found that public facilities were stronger in programmatic guidance, training, and supervision, whereas private facilities demonstrated greater functionality in equipment maintenance and electronic reporting. However, both sectors faced significant gaps: public facilities experienced resource shortages and relied heavily on paper-based systems, while private facilities lacked integration with case notification and standardized guidelines. Scaling up the provision of HCV testing and DAA therapy in Pakistan and similar LMICs requires quality leadership and electronically supported information systems to precede future extensive investment in commodities. Leveraging the comparative strengths of private facilities, services, resources, and online reporting, alongside strengthening public supply chains, will be critical to achieving universal access to hepatitis control services.