The World Health Organization has defined specific targets for fighting HCV infection, as part of the Global Health Sector Strategy on Viral Hepatitis 2016-2021. These targets include 90% reduction in HCV incidence, diagnosis of 90% of all infections, as well as treatment of 80% of eligible patients with HCV infection by 2030 (http://apps.who.int/gb/ebwha/pdf_files/W HA69/A69_32-en.pdf?ua=1, accessed: Aug 2017). In our quest for eliminating specific viral infections, different tools serve different purposes, as elimination is a multifactorial process, its very definition stating that it is a result of deliberate efforts, and that is requires continued intervention. For infections that have the potential to generate chronic disease, the approach to elimination is complex, as we not only need to reduce the number of new cases, but also to identify, diagnose, treat and cure all patients with chronic infection. Furthermore, the relatively “silent” nature of chronic HCV infection leads to a lower  addressability of the  ndiagnosed fraction to healthcare services, compared to other infections with more prominent clinical outlines.

Virtually any elimination strategy starts with the prevention of new infections. As no anti-HCV vaccine is available as yet, awareness campaigns and harm reduction programs in high-risk groups are of utmost importance, and in Romania we have developed successful information and education campaigns for the general population and for targeted risk groups. The next step is identifying active infection, and for this, concerted efforts are needed, first to inform the population that they should get tested, then to educate and update medical practitioners on the need and the means to screen and test for HCV infection. As nationwide testing campaigns are implemented, the undiagnosed fraction decreases, and with each patient diagnosed and linked to care we are one step closer to elimination, as direct acting antivirals now provide a good rate of sustained virologic response, thus contributing to an important decrease in the pool of patients, and consequently leading to a reduction in transmission. Elimination is an ambitious goal, but the first steps on this path have already been undertaken, as micro-elimination campaigns are well underway in many countries worldwide. To approach micro-elimination, well-defined patient populations are selected, and intensive testing is deployed. One of the best characterized such clusters where micro-elimination is feasible and very much needed, is the group of patients with  hemophilia. As they are all linked to medical care, access to testing and treatment is more straightforward, and expanding on this example, further campaigns can be developed to target additional patient  groups, until macro-elimination is finally achieved.