Prioritization within current screening guidance
Public health authorities now emphasize both broad testing and focused prioritization to find undiagnosed hepatitis C virus infections. The U.S. Preventive Services Task Force recommends screening for adults aged 18 to 79, U.S. Preventive Services Task Force Agency for Healthcare Research and Quality, reflecting a move toward universal adult screening in settings with access to treatment. The Centers for Disease Control and Prevention similarly advises one-time testing for all adults aged 18 and older and testing of pregnant people during each pregnancy, Centers for Disease Control and Prevention, to reduce missed diagnoses and link people to curative therapy. These recommendations reflect improved treatments and the public-health value of finding silent infections.
High-priority groups based on risk and setting
Even with broad recommendations, certain groups remain highest priority because they carry disproportionate prevalence or transmission risk. People who inject drugs and others with recent injection exposure are central priority groups; the World Health Organization identifies people who inject drugs as a key population for screening, World Health Organization. People with HIV infection, recipients of blood transfusions or organ transplants before routine screening of the blood supply, and individuals on long-term hemodialysis also warrant prioritized testing because of higher probability of infection and clinical consequence. Additionally, people born in countries with high hepatitis C prevalence and persons who have experienced incarceration or received unsafe medical procedures in resource-limited settings should be prioritized in targeted programs, especially where local prevalence is elevated.
Causes, consequences, and the rationale for prioritization
Hepatitis C is primarily blood-borne: injection drug use, contaminated blood products before the early 1990s, and unsafe medical practices drive transmission, Centers for Disease Control and Prevention. Untreated chronic infection can progress over years to cirrhosis, liver failure, and hepatocellular carcinoma, World Health Organization, which explains the emphasis on early detection. Effective direct-acting antiviral therapies can cure most infections and prevent long-term liver damage, World Health Organization, strengthening the case for prioritizing both high-risk individuals and broader adult screening. Local epidemiology, access to treatment, and social determinants such as stigma and healthcare access shape how priorities are implemented on the ground.