Building a Low-Threshold Model for HCV Diagnosis and Treatment Among Formerly Incarcerated Patients in Alabama

Millions of Americans remain infected with hepatitis C (HCV). Innovation in care delivery is required to achieve the goal of national elimination.

Develop a low-threshold HCV treatment program.

Free clinic with mobile unit providing transitional care to people leaving jails and prisons across Alabama.

Formerly incarcerated persons, many of whom are uninsured and live in rural areas.

We utilized point-of-care diagnostics to condense the HCV screening and pre-treatment evaluation into a single encounter. Patient assistance programs were used to obtain medications for uninsured patients. Clinical support was provided through in-person and telehealth care.

From January 2023 to December 2024, 369 patients were screened for HCV; 104 (28.1%) were HCV antibody positive, and 71 (19.2%) were viremic. Of these patients, 70 completed pre-treatment diagnostics, 54 started treatment, 41 confirmed completion, 20 had SVR12 collected, with 19 achieving cure (94% cure rate). The median time from diagnosis to treatment initiation was 27 days.

It is possible to both diagnose HCV and complete the entire pre-treatment evaluation in a single encounter and initiate treatment within 1 month, even for predominantly uninsured populations in rural areas.