Meeting Patients with Hepatitis C Where They Are: Lessons from the HIV Epidemic in the USA

Despite the advent of well-tolerated and curative direct-acting antivirals (DAAs) for hepatitis C virus (HCV), rates of acute HCV infections have increased in the past decade, persistently falling short of national eradication goals. HCV elimination strategies have adopted the care cascade, a framework originating in HIV care, to assess where patients are lost at each step of diagnosis, linkage to care, receipt of DAAs, and achievement of sustained virologic response. Interventions aimed at strengthening the HIV care cascade, including community-based testing, rapid initiation of treatment, and federal funding for treatment and housing, have been instrumental in increasing the number of people living with HIV who achieve viral suppression. Widescale uptake of HCV treatment, meanwhile, continues to face barriers, from payor restrictions to provider hesitance to treat patients who use drugs, despite evidence demonstrating high rates of treatment completion among this population. HIV care has critically reframed treatment nonadherence as a need for more support, rather than as a value judgment and as a reflection of the patient's ability to receive treatment. We advocate for this approach to be applied to HCV care to provide broader and more equitable access to HCV treatment, and ultimately cure, particularly for marginalized populations such as people who use drugs (PWUD). We propose solutions for increasing HCV treatment uptake using lessons from HIV care, including using a test and treat approach to initiate DAAs during hospital admission.