Modelling suggests that more frequent screening of people who inject drugs (PWID) and an improved care cascade are required to achieve the WHO hepatitis C virus (HCV) elimination target of an 80% reduction in incidence by 2030. We determined the testing frequencies (two-yearly, annually, six-monthly, three-monthly) and retention in care required among PWID to achieve the HCV incidence reduction target through treatment-as-prevention in low (25%), medium (50%) and high (75%) chronic HCV prevalence settings. Mathematical modelling of HCV transmission among PWID, capturing testing, treatment and other features of the care cascade were employed. In low prevalence settings, two-yearly antibody testing of PWID was estimated to reach the elimination target by 2027-2030 depending on retention in care, with annual testing reducing the time by up to three years. In medium prevalence settings, if close to 90% testing coverage were achieved then annual antibody testing of PWID would be sufficient. If testing coverage were lower (80%), six-monthly antibody testing with at least 70% retention in care or annual HCV RNA/cAg testing would be required. In high prevalence settings, even three-monthly HCV RNA/cAg testing of PWID alone was unable to achieve the incidence reduction target. Thus, for geographical areas or sub-populations with high prevalence, WHO incidence targets are unlikely to be met without three-monthly RNA testing accompanied by other prevention measures. Novel testing strategies, such as rapid point-of-care antibody testing or replacing antibody testing with RNA tests as a screening tool, can provide additional population-level impacts to compensate for imperfect follow-up or testing coverage. This article is protected by copyright. All rights reserved.
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The authors gratefully acknowledge the support to the Burnet Institute provided by the Victorian Government Operational Infrastructure Support Program. RSD, AP, JD, AT and MH are the re-cipients of National Health and Medical Research Council fellowships/