Implementing a Social Work-Led Hepatitis C Treatment Model for Individuals with Substance Use Disorders in Primary

Q: How does the social work-led model influence HCV cure rates?

The researchers found that 85.2% of patients who initiated treatment achieved a Sustained Virologic Response (SVR12). This high cure rate was supported by an average of seven social work encounters per patient, ensuring consistent care navigation and support throughout the antiviral therapy process.

Q: What specific substance use categories impacted treatment initiation?

According to the study's authors, individuals with stimulant use disorders (p < 0.03) or sedative-hypnotic use disorders (p < 0.003) were significantly less likely to start therapy. Despite these lower initiation rates, those who did begin treatment achieved cure rates consistent with other subgroups.

Q: Why was the Licensed Clinical Social Worker (LCSW) central to this primary care model?

The LCSW coordinated three core services: harm reduction counseling, social determinants of health screening, and care navigation. This multifaceted approach allowed the clinician to address structural barriers and social circumstances that typically prevent individuals with substance use disorders from accessing specialty-based medical care.

Q: What were the limitations regarding treatment initiation in this cohort?

The findings show that only 46.3% of the 190 diagnosed individuals actually initiated treatment. This suggests that while the model is effective for those who start, significant barriers still exist that prevent over half of the diagnosed population from beginning antiviral therapy.

Q: What do the authors suggest for future HCV care?

The study's authors propose that social workers can effectively lead treatment initiatives within integrated primary care. They conclude that treatment-first, harm reduction-oriented models are necessary to expand access for populations historically excluded from traditional abstinence-based or specialty-based healthcare frameworks.

Aimee Kresica¹, Katherine McDougal², Jessica Waters Davis³

¹Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Journal of Evidence-Based Social Work (2019)

|October 8, 2025

Summary

Social workers effectively led hepatitis C virus (HCV) treatment in primary care for individuals with substance use disorders (SUDs). This treatment-first model achieved high cure rates, demonstrating improved access and outcomes for underserved populations.

Area of Science:

Clinical social work and infectious disease management
Integrated primary care for social work-led HCV treatment
Public health strategies for substance use disorders

Background:

Prior research has shown that Hepatitis C Virus (HCV) remains a significant public health challenge among vulnerable populations. Traditional specialty-based care often excludes individuals with active Substance Use Disorders (SUDs) due to strict abstinence requirements. These barriers prevent many patients from accessing life-saving Direct-Acting Antivirals (DAAs) that could eliminate the infection. Integrated primary care settings offer a potential venue for expanding reach, yet the optimal staffing structure for such programs remains debated. Social determinants of health frequently complicate medical adherence in community-based clinics. The historical reliance on specialist-led models has created a bottleneck in the treatment pipeline for marginalized groups. This absence of evidence motivated the evaluation of a novel, non-physician-led coordination strategy.

Purpose Of The Study:

This investigation assessed the efficacy of a social work-led, treatment-first model for managing Hepatitis C Virus (HCV) within an integrated primary care environment. Researchers sought to determine if removing abstinence-based prerequisites would improve clinical outcomes for individuals with Substance Use Disorders (SUDs). The project focused on the specific role of a Licensed Clinical Social Worker (LCSW) in coordinating complex care pathways. Analysis targeted the relationship between various substance use categories and the likelihood of starting antiviral therapy. The team aimed to quantify Sustained Virologic Response (SVR12) rates among patients historically marginalized by the healthcare system. Evaluating the impact of harm reduction counseling on treatment retention served as a secondary objective. This study intended to demonstrate that social workers could successfully manage the logistical and social complexities of infectious disease care.

Main Methods:

A retrospective cohort evaluation utilized Electronic Health Record (EHR) data from a four-year period between 2018 and 2021. The study population included individuals with confirmed Hepatitis C Virus (HCV) identified through psychiatric programs and community referrals. A Licensed Clinical Social Worker (LCSW) provided harm reduction counseling and social determinants of health screening to all eligible participants. Statistical analysis employed descriptive and bivariate methods, specifically Chi-square (χ2) tests and t-tests, to compare patient subgroups. The primary outcomes measured were the rates of treatment initiation and the achievement of Sustained Virologic Response (SVR12). Investigators tracked the frequency of social work encounters to understand the intensity of the intervention required for success. All individuals medically appropriate for primary care treatment received offers for Direct-Acting Antivirals (DAAs) regardless of their current substance use status.

Main Results:

Out of 190 individuals diagnosed with Hepatitis C Virus (HCV), 88 participants initiated therapy with Direct-Acting Antivirals (DAAs). The study found that 85.2% of those who started treatment achieved a Sustained Virologic Response (SVR12), indicating a successful cure. Patients received a mean of seven social work encounters, with all treated individuals utilizing three core supportive services. Cure rates remained consistent across different Substance Use Disorder (SUD) subgroups, suggesting the model's broad effectiveness. Individuals with stimulant use disorders were significantly less likely to begin treatment, as indicated by a p-value below 0.03. Sedative-hypnotic use disorders also correlated with lower initiation rates, showing a statistical significance of p < 0.003. The data revealed that 46.3% of the total diagnosed cohort successfully transitioned into the treatment phase.

Conclusions:

Social workers possess the necessary expertise to lead Hepatitis C Virus (HCV) treatment initiatives within integrated primary care settings. Adopting a treatment-first approach effectively addresses structural barriers that previously limited access for individuals with Substance Use Disorders (SUDs). These findings suggest that harm reduction-oriented models can achieve high cure rates without requiring patient abstinence. Future implementation efforts should focus on improving engagement for patients using stimulants or sedative-hypnotics. Expanding the role of the Licensed Clinical Social Worker (LCSW) could bridge the gap between diagnosis and cure in community health. This framework provides a scalable solution for reaching populations historically excluded from specialty-based medical care. The researchers conclude that social work-led models are essential for expanding the reach of modern antiviral therapies.

Keywords:

Social work harm reduction hepatitis C integrated care substance use disorders treatment-first model

Frequently Asked Questions

The researchers found that 85.2% of patients who initiated treatment achieved a Sustained Virologic Response (SVR12). This high cure rate was supported by an average of seven social work encounters per patient, ensuring consistent care navigation and support throughout the antiviral therapy process.

According to the study's authors, individuals with stimulant use disorders (p < 0.03) or sedative-hypnotic use disorders (p < 0.003) were significantly less likely to start therapy. Despite these lower initiation rates, those who did begin treatment achieved cure rates consistent with other subgroups.

The LCSW coordinated three core services: harm reduction counseling, social determinants of health screening, and care navigation. This multifaceted approach allowed the clinician to address structural barriers and social circumstances that typically prevent individuals with substance use disorders from accessing specialty-based medical care.

The findings show that only 46.3% of the 190 diagnosed individuals actually initiated treatment. This suggests that while the model is effective for those who start, significant barriers still exist that prevent over half of the diagnosed population from beginning antiviral therapy.

The study's authors propose that social workers can effectively lead treatment initiatives within integrated primary care. They conclude that treatment-first, harm reduction-oriented models are necessary to expand access for populations historically excluded from traditional abstinence-based or specialty-based healthcare frameworks.

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