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Hepatitis C FAQs
FAQs on the Frontlines: Hepatitis C Care Beyond the Clinic

Released: June 24, 2025

Expiration: June 23, 2026

Richard R. Andrews
Richard R. Andrews, MD, MPH
Brett J. Feldman
Brett J. Feldman, MSPAS, PA-C
Sarah E. Rowan
Sarah E. Rowan, MD
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Key Takeaways
  • HCV treatment is safe and effective for people with substance use disorders and should not be delayed because of ongoing substance use or treatment for substance use.
  • Tailored approaches such as street medicine are essential for treating HCV in underserved, vulnerable populations.  

In this discussion, 3 experts explore key considerations for the treatment of hepatitis C virus (HCV) in key populations, including individuals taking HIV pre-exposure prophylaxis (PrEP), those with substance use disorders (SUDs), and people experiencing housing instability. They also discuss a street medicine model for reaching people who have been excluded from traditional healthcare settings.

For more discussion of HCV care in nontraditional settings, listen to the on-demand webinar.

Are there any concerns about drug–drug interactions between HCV direct-acting antivirals and HIV PrEP? 

Sarah Rowan, MD:
Tenofovir levels, when in the form of tenofovir disoproxil fumarate (TDF), may be slightly elevated with sofosbuvir (SOF)/velpatasvir (VEL), so if you have a patient with increased risk of renal dysfunction, you may need to  monitor  more often. If needed, you can still coadminister SOF/VEL with TDF products without dose adjustments, but it is important to be mindful of the potential interaction and avoid the combination in patients with creatinine clearance <60 mL/min. For those individuals, you could give a TAF-based regimen or use a different DAA.

Do you consider any specific precautions when treating HCV in people with SUDs or people who are taking medication-assisted therapy for opioid use? 

Richard R. Andrews, MD, MPH:
Receiving therapy for opioid use disorder should not make any difference in terms of HCV treatment. Methadone has interactions with many different drugs, but that does not include any HCV medications.

Apart from stigma, a common reason to delay treatment initiation used to be a concern that the HCV medications were not going to be as effective in individuals who use drugs. However, we now have solid data that show that simply is not the case. The therapeutic efficacy of direct-acting antivirals is similar among people with and without SUDs. So that should not be a factor in determining whether or not an individual should be treated for HCV.

Sarah Rowan, MD:
Concerns regarding the risk of HCV reinfection among people with SUDs also should not prevent us from initiating treatment. The rate of reinfection is quite low, approximately 5% to 10% for people who inject drugs. It is more advantageous to get treated because if people are using drugs and sharing equipment, then that is a potential for transmission. Curing their HCV infection addresses the risk for transmission.

How do you approach HCV treatment for people who are experiencing housing instability?

Sarah Rowan, MD:
My main concern for them is access to care and whether they have a safe place to store their HCV medication.

For people who have a safe place to store medication, I will dispense the whole amount at once. But if they do not, I have the option to ship HCV medications to a syringe service program. Syringe service programs or medication-assisted therapy clinics can also help patients store their HCV medications if they receive the whole course at once. For these patients, I find that being proactive about the potential of lost medications is critical for supporting adherence and completion of treatment.

In a similar vein, if someone has major food insecurity, I might choose SOF/VEL over glecaprevir/pibrentasvir because glecaprevir/pibrentasvir is supposed be taken with food. Strategizing with people about overcoming their individual barriers is key.

Brett J. Feldman, MSPAS, PA-C:
This is where the street medicine model really comes into play; for reaching people who have been excluded from traditional healthcare. Usually the pharmacy dispenses the medications, but in the street medicine model, we either dispense them ourselves or deliver them. This model works for many other medications, not just HCV treatment. We carry approximately 60 medications in our backpack as inventory, and we dispense them to patients on the street.

Forty-six states have laws legalizing physician dispensing, but specific rules and regulations differ from state to state. In most states, if you are licensed to prescribe, you are also licensed to dispense. If you are interested in implementing a street medicine model, you should research your state’s laws and make sure to follow those regulations.

How do you obtain funding for HCV street medicine programs? How can I help patients get free or reduced-cost medications?

Brett J. Feldman, MSPAS. PA-C:
For providing medical care, my clinic gets funding from the government and bills Medicaid and Medicare.

We also have a public health role and a role in crisis prevention and postcrisis management, which have to do with public health and public safety. These aspects of my clinic get some funding from the government.

Richard R. Andrews, MD, MPH:
The National Clinician Consultation Center is an amazing resource. This is a CDC-funded program that is hosted at the University of California San Francisco. The National Clinician Consultation Center offers free consultations on HCV management and HIV and addiction medicine, either via telephone or a chat box feature on its website. This is a valuable source of information, but I also encourage healthcare professionals to search for local assistance programs for medication for people who are uninsured.

Want more discussion of HCV care in nontraditional settings? Hear more from these question and answer sessions with this on-demand webinar.

Your Thoughts
What strategies do you use to reach people with SUDs or housing instability? Do the ideas discussed here motivate you to reach out more to these populations? Leave a comment to join the discussion!

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