Abstract
Abstract Introduction: Hepatitis C virus (HCV) infection remains a major public health challenge, particularly among patients undergoing dialysis, who are disproportionately vulnerable and at increased risk of transmission. Micro-elimination strategies targeting high-risk subpopulations are a critical component for achieving the World Health Organization global HCV elimination goals. Methods: This national, multicenter, prospective implementation study was conducted within the framework of the Brazilian Registry for the Elimination of HCV in Dialysis Units. All 904 active dialysis units in the country were invited; 384 (42.5%) joined voluntarily, and, within each, all eligible patients were enrolled (census) between 2021 and 2024. The HCV cascade of care was evaluated, including serological screening (anti-HCV), virological confirmation (HCV-RNA), treatment with direct-acting antivirals (DAAs), and assessment of sustained virologic response (SVR). Results: A total of 66,601 patients were evaluated, yielding a national anti-HCV prevalence of 2.08%. HCV-RNA testing coverage reached 65.4%, with a positivity rate of 64.2% among those tested, resulting in an adjusted prevalence of active viremia of 1.34%. Among patients with detectable viremia, 74.2% initiated antiviral therapy, 92.6% completed treatment, and 93.3% achieved SVR. The main barriers identified along the cascade of care included limited availability of diagnostic tests and patient mortality. Discussion: These findings indicate that Brazil has achieved robust therapeutic effectiveness indicators, placing the country at an advanced stage toward HCV elimination within the dialysis population. Nonetheless, important operational gaps persist, particularly in diagnostic confirmation. Conclusion: Elimination of HCV in dialysis units is an achievable goal in Brazil. Sustained success depends on maintaining universal screening, ensuring prompt treatment initiation for confirmed cases, and strengthening continuous integration between services.