One Stop Shop Model of Hepatitis B Virus Case Management and Hepatitis C Virus Elimination among Men who have sex with men and Transgender Individuals in Lahore Punjab and Larkana Sindh, Pakistan

In Pakistan, a significant portion of the population lives with viral hepatitis, a group of infections that attack the liver. Two main types, Hepatitis B and Hepatitis C, can cause long-term damage, leading to serious illness or liver failure if left untreated. While these viruses are known to spread through blood and bodily fluids, they often go undetected in specific groups of people who face barriers to standard medical care. These groups, known as key populations, include men who have sex with men and transgender individuals. In many places, these communities avoid hospitals due to fear of discrimination or a lack of understanding from medical staff. Consequently, they may not know they are infected until it is too late. To reach these people, health workers often rely on community organizations that have earned the trust of these groups. The challenge has been how to bring advanced testing and treatment directly to them without forcing them to navigate a complex and often unwelcoming hospital system.

A team of researchers set out to solve this problem in two cities in Pakistan, Lahore and Larkana, by creating a streamlined approach to finding and treating these infections. They worked with local community groups to bring testing directly to men who have sex with men and transgender individuals. The goal was to see how common these liver infections were in these populations and to test a new way of delivering care that combined screening, diagnosis, and treatment into a single visit. This method, called a "one-stop shop," aimed to eliminate the long waits and multiple trips that usually cause people to drop out of care. By using rapid testing machines that could give results on the same day, the team hoped to keep people engaged from the moment they were screened until they were cured.

The study involved more than two thousand participants recruited through trusted community organizations. The researchers first used quick, finger-prick tests to check for signs of Hepatitis B and Hepatitis C. If a person tested positive on these initial screens, they immediately underwent a more precise molecular test to confirm the diagnosis. For this confirmation, trained staff collected blood samples from the participants and transported them to laboratories in Lahore and Larkana where GeneXpert machines were located. The samples were tested, and the reports were issued on the same day and delivered back to the community organizations. Once confirmed as HCV RNA positive, patients were called to the facility to collect their medicines and undergo additional blood tests, such as Complete Blood Count and AST testing, to calculate an APRI score and determine the appropriate treatment duration. For Hepatitis C, the treatment involved taking medication for a few months to clear the virus. For Hepatitis B, which often requires lifelong monitoring, the team connected the patients with nearby public health facilities for ongoing care.

The results revealed that these infections were indeed present in the communities studied, but the rates differed between the two groups. Among the men who have sex with men, nearly five percent were found to have Hepatitis B, and more than thirteen percent had evidence of Hepatitis C. In contrast, the transgender participants showed lower rates, with about one percent testing positive for Hepatitis B and roughly four percent for Hepatitis C. The researchers found that the "one-stop" model worked well for getting people into care. Most people who were diagnosed with Hepatitis C started their treatment, and the vast majority of those who completed the full course of medication were successfully cured, meaning the virus was cleared from their bodies.

However, the study also highlighted a persistent challenge. While the system worked smoothly for men who have sex with men, transgender individuals faced higher rates of dropping out before finishing their treatment. The researchers noted that this gap was partly due to difficulties in tracking patients within the national health system. In one of the provinces, the electronic medical records used to monitor treatment progress relied on national identity cards that many transgender individuals did not possess or could not use effectively in the system. This administrative hurdle made it harder to ensure they returned for follow-up visits. Additionally, the study found that transgender individuals had lower rates of being cured compared to men who have sex with men, even though they started treatment at similar rates.

The researchers concluded that bringing testing and treatment directly to the community through trusted organizations is a viable and effective way to fight viral hepatitis among these hard-to-reach groups. The success of the same-day testing and treatment model suggests that it can be scaled up to help more people. Yet, the findings also made it clear that technical solutions alone are not enough. To truly eliminate the disease, the health system must adapt to include transgender individuals, ensuring they can be registered and tracked just like any other patient. By combining community trust with modern, rapid diagnostics and fixing the administrative gaps that leave people behind, Pakistan can move closer to its goal of eradicating these liver infections.