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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

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HCV Simplified Guidance: Assessment of Cure

The good news is that we can cure patients of HCV. But what happens after patients complete treatment?

The way to assess for cure is to obtain quantitative HCV RNA and a hepatic function panel. If HCV RNA is undetectable ≥12 weeks after treatment completion, the patient is said to have achieved sustained virologic response at 12 weeks, which is equivalent to HCV cure.8

If the patient does not have cirrhosis, no further follow-up is needed. However, if the patient has cirrhosis, continued surveillance for esophageal varices and HCC are needed.8

Patients with ongoing risk for HCV reinfection should be provided with risk reduction counseling, including retesting for HCV RNA annually. This is currently recommended for all people who inject drugs and men who have sex with men with frequent sexual encounters.8

If cure is not achieved, patients may be retreated in a community-based setting if the HCP feels comfortable. For more complex cases, patients should be referred to specialists for retreatment.8  

All patients should also receive counseling to avoid excessive alcohol intake. In patients with liver disease, there is no level of alcohol use considered to be safe. Finally, if patients continue to have elevated transaminases, they should be evaluated for other causes of liver disease.8

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Harm Reduction: What It Is and What It Does

As we expand treatment for HCV, we should also be integrating harm reduction, particularly for populations disproportionately affected by HCV such as people who inject drugs.

What is harm reduction? It is working with patients to decrease medical, social, and economic harms from drug use, both for themselves and others around them.44-46

Harm reduction tools include44-46:

  • Opioid substitution therapy, such as methadone or buprenorphine
  • Needle syringe programs to provide clean needles, so people do not have to reuse or share them
  • Access to naloxone for overdose reversal and education for overdose prevention
  • Testing and treatment for HIV, HCV and other infectious diseases to protect the health of the individuals with these infections and prevent transmission to others

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Harm Reduction Counseling

The key points to focus on during harm reduction counseling are ways to reduce risk.

This includes discussing safe injection practices and linking people to local resources for syringe service programs. Patients should also be linked to treatment for their substance use disorder, including offer of medications for opioid-use disorders if indicated and willing.47

Individuals at high risk for HCV acquisition through high-risk sexual practices should be counseled on safe sex practices, including the increased risk for HCV acquisition associated with multiple partners, drug use during sex, shared sex toys, or engaging in intercourse with skin tears. Patient education may empower patients to make choices that reduce their subsequent risk.47

Individuals who engage in heavy alcohol use should be counseled to abstain or limit alcohol intake, as there is no safe level of alcohol use for patients with existing liver disease. Even for those without liver disease, heavy alcohol increases the risk for liver damage.47

Patients should also be counseled to avoid taking medications unless they are necessary and prescribed or overseen by health workers, as many medications could potentially be hepatotoxic. Vaccination against hepatitis A and B viruses can also protect from further hepatitis-associated liver damage from acquisition of hepatitis A or B infection.47

Finally, it is also important to reduce stigma by letting patients know that HCV is not spread by casual contact through common daily activities such as coughing, sneezing, kissing, or sharing utensils.47

When implemented effectively, harm reduction reduces HIV and HCV transmission, prevents overdose death, improves overall health for people who use drugs, and is an important component in the fight to eliminate HCV.47

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