Hepatitis Free Hospital: Retrospective Results of an In-Hospital Project of Hepatitis C Virus Micro-Elimination

National HCV screening, a cost-effective program in Italy, is supported by the Italian Ministry of Health. Free-of-charge screening was approved for people who use drugs, prisoners and the 1969–1989 general population birth cohort. However, the benefits of extending hospital-based screening irrespective of age, in terms of case detection and linkage to care, remain unclear. We assessed a streamlined in-hospital pathway at San Giuseppe Hospital (Milan), between 2021 and 2024, with anti-HCV screening for all admissions and HCV-RNA confirmation when indicated. Anti-HCV seroprevalence among 18,218 screened patients was 1.9% (medical wards 3.8%, surgical 1.4%). Viremia was detected in 23/75 tested (31%); 78% linked to care and 30% initiated treatment. Notably, 91% of viremic patients were born before 1969 indicating hospital-based screening effectively identifies HCV infections in older cohorts missed by national screening programs. Systematic screening implementation across hospital wards represents a pragmatic micro-elimination strategy for Italy and similar epidemiological contexts, advancing 2030 elimination targets.