Regional administrations have treated almost twice as many people as initially expected. Yet much work remains to be done before Spain can achieve its goal of eliminating the disease. Even as the per patient cost of administering new direct-acting antiviral (DAA) drugs falls, the country may have to commit further resources to detecting potentially thousands of as-yet unidentified Hepatitis C virus (HCV) patients. Doing so would bring relief for many more sufferers and their families, as well as delivering long-term benefits for the health system, as fewer would develop related fatal diseases or require a liver transplant.

Financial and structural barriers may impede further progress, however. Beyond the cost of mounting a campaign to detect remaining HCV cases is the challenge associated with a fragmented healthcare system. This fragmentation can lead to overlooking those most at risk, or losing them when their treatment pathways are too complex.

In particular, prison inmates, immigrants, people who inject drugs (PWIDs) and those who practice unsafe sex may not have regular, or any, contact with the health service, which could provide an opportunity for care. In the general population, thousands of people are estimated to carry the virus and remain undiagnosed. Many older patients may have been infected via blood products and hospital procedures, before the virus was discovered and tests for the virus made available.

The key findings of the research are:

• Spain has made substantial efforts, treating almost 100,000 HCV sufferers in three years, most of whom have cleared the virus from their blood.
• The goal of eliminating Hepatitis C in Spain is in sight, but may not be reached due to flagging efforts to detect and treat remaining patients.
• Hepatitis C could be eliminated relatively easily if resources were allocated and services within the health system harmonised.
• Focusing on the most long-standing, serious cases of HCV with advanced liver fibrosis, then widening access at a later stage was the strategy adopted in Spain.
• With the most urgent cases cleared, more must be done to reach those who present with signs of infection, as well as those who do not know they may be HCV-positive.
• Registers of who is being screened and the results of screening need to be created to ensure a more accurate picture of the task ahead.
• More outreach work and local service provision would improve detection and treatment among high-risk groups, such as PWIDs, those who practice unsafe sex and the prison population.
• A law change may be required to allow treatment in renal dialysis centres, drug dependency clinics and prisons.
• Public campaigns are needed to encourage individuals who may have been exposed to the virus to ask for a HCV test.
• Reaching a wider population will require significant spending—for education programmes, frontline screening, provision of diagnosis equipment and facilities, and provision of treatment and aftercare.