Beyond Training: Expanding Primary Care Capacity for Hepatitis C Treatment in an Integrated Health System Serving Southwest Virginia

Abstract Background Chronic hepatitis C virus (HCV) infection remains a major challenge in rural US communities, where limited specialist availability restricts access to effective direct-acting antivirals (DAAs). Primary care-based HCV treatment models are clinically effective, yet uptake remains low. We implemented a training and care coordination program within our southwest Virginia health system to address this gap. Methods We conducted a retrospective pre-post evaluation of an HCV program initiated in June 2023, comprising educational modules, webinar series, specialist consultation, and a dedicated HCV Coordinator. Adults with a qualifying HCV RNA result who initiated DAA therapy between January 1, 2022, and February 28, 2025, were included; prescribing providers were grouped by specialty (Family Medicine, Internal Medicine, or Specialist). The primary outcome was expansion of FM treatment capacity. Secondary outcomes included travel distance and time to treatment. Results Of 828 candidate patients, 587 met eligibility criteria. FM providers initiating DAA therapy increased from 12 to 31, and clinic sites from 6 to 17. FM treatment volume increased from 13 to 40 patients (+208%), a significantly greater increase than other specialties combined (OR=2.90, p<0.001). Most newly involved FM prescribers engaged with the program, via the HCV Coordinator. Compared with specialist care, patients treated in FM had shorter travel distances (5.9 vs 18.9 miles; p<0.001) and a non-significantly shorter time to initiation (44 vs 71 days; p=0.15). Conclusions A multifaceted implementation program combining provider education with centralized care coordination was associated with targeted expansion of FM treatment capacity and improved geographic access to HCV care.