C the Change: Six Innovations Reshaping Hepatitis C Testing and Treatment
Elimination of hepatitis C virus (HCV) will require moving care beyond clinic walls and into the community spaces where patients live, work, and seek support. That’s the take-home message from a series of presentations at IDWeek 2025, in Atlanta, showcasing new strategies aimed at closing persistent gaps in HCV testing, linkage, and treatment, particularly for populations disproportionately disconnected from traditional care.
A Mobile Pharmacy
The session opened with a look at “InMotion,” a full-formulary mobile pharmacy clinic launched in Connecticut through a National Institute on Drug Abuse (NIDA) Avant-Garde Award given to principal investigator Sandra A. Springer, MD. As Angela Di Paola, PhD, a postdoctoral research associate at Yale, in New Haven, Connecticut, explained, the model grew out of Dr. Springer’s recognition that people who use drugs face a multilayered set of barrier—including transportation, stigma, mistrust, unstable housing, competing priorities—that often make even a single clinic visit out of reach.
“We are able to give out medications within two visits,” she said, noting that the team dispenses direct-acting antivirals (DAAs) on board the mobile unit after rapid evaluation and lab review. Once a new point-of-care HCV RNA PCR device is activated for use on the mobile pharmacy, she said, “we’re hoping that we’ll be able to change over to one-day treatment initiation.”
InMotion’s early data show that among individuals reached by the mobile pharmacy, nearly 70% of those with HCV were unhoused and a similar proportion reported active substance use, precisely the group least likely to engage in conventional hepatology care. “We have to meet them where they are,” Dr. DiPaola emphasized. “If all your belongings are in a plastic bag, you’re not going to leave them on the sidewalk for two hours to go to a doctor appointment.”
Taking Point-of-Care to the Street
A complementary approach came from Henry Ford Hospital and the CHASS Center, which provides medical services to the uninsured and underinsured populations of Detroit. Infectious disease fellow Kyle Crooker, MD, described a multidisciplinary street-medicine team integrating recently CLIA-waived point-of-care HCV RNA testing. The Cepheid Xpert RNA platform, authorized in 2024, returns qualitative results in under an hour, enabling rapid confirmation while the team is still in the field.
People experiencing homelessness remain one of the most underserved HCV populations, with multiple treatment barriers, Dr. Crooker noted. The feasibility pilot tested 93 individuals: “17 were RNA-positive, 11 started treatment, and 10 completed it,” he said. Seven achieved undetectable end-of-treatment viral loads, with early sustained virologic response data emerging.
Weekly contact and modified directly observed therapy proved crucial. “This work is hard. Street-based initiatives are resource-intensive,” he acknowledged. “But people showed a genuine interest in diagnosis and treatment once trust was built.”
Telehealth at the Needle Exchange
Beginning in 2022, Denver Health implemented a telehealth-based HCV treatment model embedded in syringe service programs (SSPs). The program offered drop-in video visits with an HCV provider, onsite labs, and medication delivery and storage at the SSP.
The team found strikingly high acceptability, reported Sarah Rowan, MD, an associate professor of medicine and the director of the Division of HIV/STI/Viral Hepatitis at the Public Health Institute at Denver Health. “In pilot surveys, 88% of clients said they would be more likely to get treated if the care was offered at the SSP,” she said. Treatment initiation increased substantially in the first year once telehealth was integrated, particularly among individuals with recent injection drug use; 91% of the cohort was Medicaid-insured, and in 2023 Colorado Medicaid removed the requirement for DAA prior-authorization, further enabling access to care.
Harnessing Meds to Beds
Hospitalization itself can be a key opportunity for HCV screening and treatment, reported Laura Marks, MD, PhD, an assistant professor of medicine at Washington University in St. Louis.
After the institution implemented a “Meds to Beds” model in 2022, involving automatic inpatient ID consultation, rapid assessment, insurance coordination, and medication delivery to the bedside, 98% of 249 eligible patients received approved DAAs before going home with a 74.8% treatment completion rate. Before the program, only 7.6% of hospitalized patients with active HCV at her institution started DAAs within six months of discharge, and just 4.3% reached cure.
Dr. Marks emphasized that treatment barriers are typically not clinical complexity but logistical issues, including lack of phone access, unstable housing, or repeatedly missed outpatient appointments. “Hospitalization is an opportunity,” she said. “If we don’t start treatment while they’re with us, we may not get another chance.”
Using Big Data for Inpatient Alerts
At the Durham Veterans Affairs Healthcare System in Durham, North Carolina, ID specialists leveraged the Veterans Health Administration’s national HCV registry to generate real-time inpatient alerts whenever a veteran with untreated HCV is admitted. “Our alerts captured all veterans with active hepatitis C regardless of where or when they were diagnosed,” explained Edwin (Will) Wilbur Woodhouse III, MD, MPH, an assistant professor of medicine at Duke University School of Medicine, in Durham, North Carolina. “A Data-2-Care approach to hepatitis C treatment is needed and can be successful, as demonstrated by this work.”
Among 17 treatment-eligible veterans identified, 16 initiated DAAs, 13 of those during hospitalization. More than half achieved SVR4 despite profound barriers, including advanced fibrosis and long gaps since diagnosis (median 13 years). Fewer than one-fourth were able to attend outpatient follow-up, underscoring the importance of inpatient initiation, Dr. Woodhouse noted.
Communication Is Key
Linkage to care programs must be prepared to withstand system strain and adapt to communication gaps, stressed medical student Emma Nedell, MPH, who presented a four-year analysis of an ED-based hepatitis C screening and treatment cascade at UMass Memorial Health, in Boston. The program’s data revealed how sharply progress can erode during public health disruptions: LTC rates declined by more than 10% in the first two years of the COVID-19 pandemic, falling from 46.6% pre-pandemic to 35.6% from March 2020 through October 2022 (P=0.013).
Among 1,226 individuals identified with past infection and 550 with active infection, the biggest predictor of successful linkage was contactability; 97.6% of linked patients had a working phone number versus 84.7% of those who were not linked. Nedell emphasized that the pandemic highlighted the fragility of ED-based HCV cascades and the need for programs to build redundancy into patient communication and follow-up systems.
By Gina Shaw