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Hepatitis C Care
Breaking the Cycle: Hepatitis C Care in Nontraditional Settings

Released: April 23, 2025

Expiration: April 22, 2026

Oluwaseun Falade-Nwulia
Oluwaseun Falade-Nwulia, MBBS, MPH
Activity Information

Activity

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Key Takeaways
  • People who are incarcerated and experiencing homelessness are disproportionately affected by hepatitis C virus (HCV).
  • Testing and treating HCV in nontraditional settings is a practical, proven method to improve access to care for vulnerable populations.
  • Use of a point-of-care HCV RNA test and simplified treatment approach allows for efficient and effective HCV care.

Hepatitis C virus (HCV) infection is a leading cause of chronic liver disease, liver cancer, and liver-associated mortality. This is especially unfortunate as we have simple oral treatments for HCV infection. Direct-acting antiviral medications for HCV achieve cure in over 95% of people that have access to and take the recommended regimens of 1 to 3 pills once a day for 8 to 12 weeks. Cure is associated with a reduction in the risk for progression of liver disease to liver failure, liver cancer, or even death.

Unfortunately, the vast majority of people who have HCV have not been diagnosed. Even when diagnosed, many people are not linked to care or provided treatment.

Populations Disproportionately Affected by HCV
One of the reasons HCV remains a public health challenge despite the availability of effective treatment is the fact that people from vulnerable populations are disproportionately impacted by HCV.

In the US, the majority of new HCV infections are in people who use or inject drugs related to bloodborne transmission through shared injection or drug use paraphernalia. Other groups disproportionately impacted by HCV include people who are incarcerated and people who are experiencing homelessness. Ultimately, we need to do better at making care accessible to all people with HCV infection.

Barriers to HCV Care
It can be complex for vulnerable populations to access HCV care at specialist centers or in traditional healthcare settings like outpatient infectious disease clinics or even general hospitals. The barriers to care are often multilevel, including transportation challenges, financial difficulties, lack of insurance coverage, and limited health information. Stigma related to substance use, which predisposes people to HCV infection in the first place, remains a major barrier to seeking care for HCV infection.

Nontraditional Settings
There are multiple settings where populations disproportionately impacted by HCV routinely access services. Strategies that integrate HCV treatment into these settings have potential to increase HCV treatment uptake.

Thus, to move closer to the World Health Organization’s goal of eliminating HCV by 2030, we need to expand routine availability of HCV testing and treatment to nontraditional settings.

HCV Point-of-Care Testing
A point-of-care antibody test for HCV has been available for more than a decade, and can provide information on whether or not a patient has been exposed to hepatitis in just 20 minutes.

Even better, in June 2024, a point-of-care HCV RNA test was approved that can diagnose current HCV infection within 1 hour of sample collection. There are still a number of barriers we have to overcome related to routine implementation of point-of-care HCV RNA testing, including the cost. But it does give us a glimmer of hope that in 1 visit, we are able to provide information to a person about their hepatitis C status, which moves them closer to potential treatment if indicated.

Simplified Treatment
The American Association for the Study of Liver Diseases and Infectious Disease Society of America simplified HCV treatment algorithm, provides an approach to HCV treatment that can be used by many provider types to provide HCV treatment in a range of settings. There are data showing that hepatitis C treatment in a broad range of settings by a broad range of healthcare professionals is associated with cure rates that are as high as those achieved in specialist centers.

When people with HCV are cured, the cycle of transmission is broken, bringing us closer to elimination of HCV altogether.

Learn More
To learn how you can implement HCV screening and care in nonspecialty clinics and nontraditional settings—such as primary care settings, syringe service programs, medication-assisted treatment programs, community health clinics, and street outreach programs—join our live, interactive online workshop.

Your Thoughts
What are the most common barriers to HCV care you face in your community? What strategies do you use to overcome them? Leave a comment to join the discussion.