Ask AI
Back Back
HCV Care in Nontraditional Settings

CE / CME

HCV Care in Nontraditional Settings: A Focus on Vulnerable Populations

Social Workers: 1.00 ASWB ACE CE Credit

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: June 02, 2025

Expiration: June 01, 2026

Oluwaseun Falade-Nwulia
Oluwaseun Falade-Nwulia, MBBS, MPH
CME/CE Information

Activity

Progress
1 2
Course Completed

Primary Care-Based HCV Treatment

The good news is that there are success stories of HCV care in nonhepatitis settings.

One such success story is a primary care model of HCV treatment at the Grady Liver Clinic in Atlanta, Georgia. This clinic is staffed by general internists with expertise in HCV management and treatment. Other members of the team include a clinical pharmacist, pharmacy technician, patient manager, and program manager.37

In this clinic, 77% of those with HCV were initiated on treatment, with high percentages of treatment completion, and cure.37

The success of this program is attributed to the continued support for faculty time dedicated to the Liver Clinic at Emory University’s Division of General Internal Medicine, as well as support from the larger Grady Health System, including provision of clinical and financial resources provided through participation in the 340B program. A systematic screening approach, coupled with linkage to care, patient navigation, and program management also contributed to the success of this model.37

This model also demonstrates that primary care providers can and should provide HCV care. Of importance, the systematic screening approach used here could also be implemented at other clinics to facilitate access to HCV care. 

Download

CHARM Program: HCV Test and Treat Program in Sexual Health Clinics

Another success story is a test-and-treat program implemented at sexual health clinics run by the Baltimore City Health Department, which sought to integrate HCV care into a setting traditionally aimed at reaching medically underserved populations.38

These clinics implemented rapid HCV testing, with confirmatory RNA testing sent to a commercial lab. Additional services provided included sexually transmitted infection testing and treatment, as well as HIV prevention, treatment, and case management. Services were free to patients regardless of insurance status.38

Among 560 patients accessing care in these clinics, 75.5% were evaluated for HCV. Among the 560, 62% attended an appointment for treatment, and 47.5% were prescribed treatment.38

It is telling that the number of patients who were prescribed treatment concurs almost exactly the proportion of patients who had stage ≥F2 liver disease. This illustrates the impact of Medicaid restrictions on HCV treatments in this setting, where at that time, only patients with ≥F2 liver disease were approved for HCV treatments. However, for patients who initiated treatments, the vast majority achieved HCV cure.38

Download

Colocating HCV Care in Harm Reduction Center

Syringe service programs are yet another nontraditional setting where HCV treatment has been successfully integrated, targeting a population that is disproportionately affected by HCV.39

In this single center, randomized, controlled trial, accessible care with HCV treatment provided by a specialist located in the syringe service program was compared to usual care, consisting of referral to a local HCP.39

These results illustrate that progress across the care continuum was significantly higher in the accessible care arm, with higher rates referrals to HCV HCPs, higher rates of initial visits , higher rates of completion of blood work, treatment initiation, and SVR. Altogether, these data showcase the impact of integrating HCV treatments in community-based settings.39

Download

ANCHOR: Novel Model of HCV Treatment as an Anchor to Prevent HIV, Initiate OAT, and Reduce Risky Behavior

In a similar vein, the ANCHOR program assessed integration of hepatitis C treatment and opioid use disorder care at a harm reduction organization in Washington, DC.40

In this study, 82% of patients achieved SVR. Despite high rates of drug use in the study cohort, SVR was not associated with on-treatment drug use or imperfect medication adherence.40

In addition, those who were receiving opioid-agonist treatment were found to have fewer opiate-positive urine drug screens, lower HIV risk-taking behavior scores, and lower rates of opioid overdose. This highlights the effectiveness of integrated strategies for people who use drugs in terms of reducing not only the harms of HCV, but the harms of opioid use as well.40

Download

Success Stories: HCV Treatment in People Who Inject Drugs in a MAT Program

As these past 2 studies show, people who inject drugs are high priority for HCV treatment. In this study from Philadelphia, a medication-assisted treatment (MAT) program for opioid use disorder integrated routine HCV care, with the opportunity to be evaluated and prescribed HCV treatment, which could be self-administered at home or via directly observed treatment at the clinic.41

Overall, between 2019 and 2021, 190 patients with HCV were identified. Among that population, 11.1% were referred to HCV specialists for care for liver complications or medical conditions outside the MAT’s scope of practice, although 88.9% of those identified to have HCV were offered treatment at the MAT program.41

Among those offered treatment, 62.7% completed therapy. Among those who completed treatments, rates of cure were high at 96.2%.4

Among those who completed treatment, approximately 69% received their treatment via directly observed treatment.

This underscores how existing resources and care pathways in this MAT were leveraged to integrate provision of HCV treatment. These data show that the MAT’s directly observed treatment program translated to high rates of HCV cure in a population that otherwise may not have had access to treatment.41

Download

Leveraging Telemedicine

Finally, telemedicine is a tool that we have all become very familiar with. It is powerful for increasing access to care for populations that might otherwise not have access. Integration of telemedicine into other settings may further expand access to care.

In a large trial conducted across 12 opioid treatment programs (OTP) in New York state, investigators assessed provision of facilitated telemedicine. People with HCV were identified at opioid treatment programs, then received HCV treatment from an off-site specialist through telemedicine, which was integrated with treatment for opioid use disorder at the OTP.42

Facilitated telemedicine was associated with higher rates of HCV treatment initiation at 92.4%, compared with 40.4% among patients who were referred to care elsewhere.

These higher rates of treatment initiation with facilitated telemedicine translated to higher rates of observed HCV cure. Facilitated telemedicine was also associated with reductions in illicit drug use and low rates of reinfection.

Another model integrated telemedicine for HCV treatment into an incarcerated setting. This study evaluated telemedicine in a correctional facility, with care led by pharmacists. Among 1014 individuals treated, 97% of patients achieved cure with no treatment discontinuations due to adverse events.43

In all, these 2 studies demonstrate the power of telemedicine to overcome transportation or geographic barriers and bring care to the people who need it most.

Download

All healthcare professionals (HCPs), even those in nonspecialty settings, can and should screen for HCV and offer treatment.

BACK | NEXT