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

Area of Science:

• Hepatology
• Public Health
• Infectious Diseases

Background:

• Despite effective direct-acting antivirals (DAAs), acute hepatitis C virus (HCV) infections are rising, hindering eradication goals.
• The HCV care cascade, adapted from HIV care, identifies patient loss points from diagnosis to sustained virologic response.
• HIV care has successfully used supportive interventions to improve viral suppression rates.

Purpose of the Study:

• To advocate for applying HIV care strategies to improve HCV treatment uptake.
• To address barriers hindering HCV elimination, particularly for marginalized populations like people who use drugs (PWUD).
• To propose solutions for increasing access to HCV treatment and cure.

Main Methods:

• Reviewing the HCV care cascade and comparing it to successful HIV care interventions.
• Analyzing barriers to HCV treatment, including payor restrictions and provider hesitancy.
• Proposing a "test and treat" approach inspired by HIV management.

Main Results:

• HIV care models demonstrate success in improving treatment adherence and viral suppression through supportive interventions.
• Evidence shows high treatment completion rates for HCV among people who use drugs, challenging provider hesitancy.
• Barriers such as payor restrictions and provider bias impede widespread HCV treatment uptake.

Conclusions:

• Reframing treatment nonadherence as a need for support, mirroring HIV care, is crucial for equitable HCV treatment access.
• Implementing lessons from HIV care, such as "test and treat" strategies during hospital admission, can increase HCV treatment uptake.
• Adopting a supportive, evidence-based approach is essential for HCV elimination, especially for marginalized populations.