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HCV Street Medicine Lessons Learned
Taking HCV Screening and Treatment to the Streets: Lessons Learned

Released: November 13, 2025

Amanda Rosecrans
Amanda Rosecrans, MD, MHS
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Key Takeaways
  • Hepatitis C virus (HCV) remains a significant public health challenge, particularly among people experiencing homelessness and those who inject drugs. These populations are often underserved by traditional healthcare systems.
  • Street medicine programs, which deliver care directly to individuals in nontraditional settings such as encampments, sidewalks, and shelters, offer a unique opportunity to bridge this gap.
  • National guidelines now recommend universal HCV screening for all adults at least once, with periodic testing for those with ongoing risk factors. Integrating HCV screening into street medicine and other nontraditional settings is not only feasible, it is essential for reaching those most at risk and reducing barriers to diagnosis and treatment.

Building a Protocol and Team Engagement
I was recently part of an initiative to introduce a formalized hepatitis C virus (HCV) screening and treatment program into an established street medicine program. One of the most valuable steps in this project was helping the team build a clear, actionable algorithm for screening and treatment. Although HCV screening and treatment are relatively straightforward, uncertainty about who to test or how to initiate treatment can often be a barrier for healthcare professionals (HCPs). A well-designed protocol can give HCPs the confidence to incorporate HCV care into their routine clinical practice.

We also supported training across the organization—not just for clinical staff but for everyone. This whole-team approach helped create a culture where HCV screening and treatment became a shared mission, not just a clinical task. 

Opt-Out Screening
Before this project, the team was conducting some HCV testing, but it was inconsistent and largely based on HCP discretion or obvious risk factors. By shifting to an opt-out screening model, aligned with CDC guidelines, we normalized testing as a routine part of care. This change alone led to a dramatic increase in screening rates.

Testing Modalities and Innovations
We performed HCV testing through point-of-care (POC) antibody testing via fingerstick, as phlebotomy is often a challenge in mobile settings. Some patients have difficult venous access, and drawing blood in the field isn’t always feasible. 

Although POC antibody testing is effective, it does require confirmatory RNA testing if positive. Newer technologies, such as POC RNA testing or dried blood spot testing, offer promising alternatives. These methods allow for RNA confirmation from a simple fingerstick. Although not yet widely adopted in the United States, they are gaining traction internationally and could be transformative for mobile and street-based care.

Navigating Treatment Access
In our program, we were fortunate to be working in a state without prior authorization requirements for HCV treatment for patients on Medicaid. In other states I’ve worked in, prior authorizations have significantly delayed care, especially when extensive laboratory results are required for approval.

Without these administrative barriers, the team was able to initiate treatment quickly, which is a critical advantage in street medicine where follow-up can be unpredictable. When developing a protocol for your site, make sure you understand local policies and procedures to ensure patients can access treatment efficiently.

Monitoring and Adapting
Once a protocol is developed and implemented, track your progress and reassess for barriers that may prevent patients who test positive from progressing to treatment. This is an ongoing process, and it may take time to determine what works best for your setting and patient population. For example, collaborating with pharmacy colleagues to explore dispensing strategies, such as daily or weekly medication pickups, can support patients who do not have a secure place to store their medications.

Lessons Learned
Based on this experience and my prior work in mobile HCV care, here are a few key recommendations for programs looking to implement or expand HCV screening in street medicine:

  1. Start with Screening: You likely already have the tools to begin. Shifting to an opt-out model and making screening routine can dramatically increase uptake.
  2. Develop a Clear Protocol: A simple, setting-specific algorithm empowers HCPs to provide screening and treatment. Don’t underestimate the value of a well-designed flow sheet.
  3. Train the Whole Team: Educate both clinical and nonclinical staff. When everyone understands the “why,” it becomes a shared priority.
  4. Know Your State’s Policies: If you’re in a state with no prior authorization requirements for HCV treatment, leverage that. If not, advocate for change—these policies matter.
  5. Track and Celebrate Progress: Regular meetings and data reviews help maintain momentum. What starts as a focused initiative can become routine practice.

Final Thoughts
Treating HCV is deeply rewarding for HCPs and profoundly impactful for patients. Treatment is curative, relatively simple, and can serve as a powerful motivator for patients working toward broader health goals. In the context of street medicine, where much of the care focuses on managing chronic conditions and addressing social determinants of health, being able to offer a cure is a rare and meaningful opportunity.

For other programs considering this work, you probably already have the tools you need. Make HCV care a priority, and the rest will follow.

Your Thoughts
What is your experience with street medicine programs, or what barriers do you see? Join the conversation by posting a comment below.

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