20 April 2026
On 18 March 2026, INHSU convened a full-day, in-person Hepatitis C (HCV) Intervention Symposium in Cleveland, Ohio, as part of our HCV Intervention Symposia Series in the United States. The symposium brought together approximately 40 highly engaged participants representing public health agencies, primary care and specialist services, harm reduction and syringe service programs, community-based organizations, and advocacy partners.
While most attendees were based in the greater Cleveland area, participants also travelled from upstate New York, Pennsylvania, and Indiana, contributing regional perspectives and actively sharing experiences from their own jurisdictions.
Designed to move beyond awareness-raising and into practical problem-solving, the Cleveland symposium focused on how evidence-based interventions can be adapted, implemented, and sustained within local systems of care. The day combined expert insights with structured group work, enabling participants to critically examine their own settings and leave with tangible strategies to strengthen HCV testing, linkage to care, and treatment.
The importance of this work is amplified in Northeast Ohio and the broader Appalachian region, where the ongoing overdose crisis has driven a high prevalence of hepatitis C, underscoring the urgent need for strengthened, community-based responses along the HCV care cascade.
From evidence to local reality
Throughout the symposium, participants engaged with current evidence on interventions that improve the HCV care cascade—including simplified testing pathways, team-based models of care, peer support, and care navigation. However, a defining feature of the Cleveland event was its emphasis on local context. Rather than treating interventions as fixed models, discussions consistently returned to the question: what does it take to make these approaches work here?
This focus came through most strongly during the facilitated group work session, where participants worked in small groups to identify barriers, facilitators, and priority actions for scaling up HCV services in their own environments. Using implementation science frameworks, groups were encouraged to move from diagnosis of the problem to actionable planning, grounding their discussions in lived experience and operational realities.
Persistent barriers along the care cascade
Across groups, participants identified a shared set of challenges that continue to undermine engagement in HCV care, particularly among people who are hardest to reach. These barriers spanned individual, organizational, and system levels.
At the patient level, unstable housing, lack of reliable phone access, and competing survival priorities were frequently cited as reasons people disengage between testing and treatment. Participants described the difficulty of contacting patients with no phone or frequent number changes, and the challenges of medication delivery and storage for people experiencing homelessness.
Policy and system-level barriers emerged as a particularly salient theme. Groups discussed long wait times—often three to four months—for specialist appointments, restrictive referral processes, and hospital-driven workflows that are poorly aligned with community-based care. Medicaid requirements, including prior authorization processes and documentation burdens for HCV treatment approval, were repeatedly identified as significant obstacles that delay treatment initiation and strain already limited staff capacity. Insurance and administrative hurdles, including reliance on complex pharmaceutical patient assistance programs, were described as time-consuming for providers and frustrating for patients.
Workforce pressures emerged as another critical constraint. Groups noted limited staffing capacity, particularly for navigation and follow-up, and the burden placed on clinicians and nurses to manage increasingly complex care coordination on top of clinical duties.
What helps care work: facilitators and enablers
Alongside these challenges, participants identified a wide range of facilitators that have shown promise locally or could be scaled with the right support. Peer support emerged as a consistent and powerful enabler across discussions. Participants emphasized that peers—people with lived or living experience—play a unique role in locating patients, building trust, supporting adherence, and bridging gaps between testing and treatment.
Groups also highlighted the importance of care navigation and “boots-on-the-ground” case management, particularly for uninsured and underinsured patients. Embedding navigation within HCV teams, rather than treating it as an external add-on, was seen as critical to reducing loss to follow-up and easing clinician workload.
Practical service adaptations featured heavily in brainstorming, including walk-in clinics, pop-up testing events, and outreach models that meet people where they are. Participants discussed the value of low-barrier engagement strategies such as incentives (e.g. gift cards), provision of basic needs (snacks, phone charging), and integrating HCV services into existing touchpoints like harm reduction outreach, mobile units, and community events.
Importantly, groups stressed that coordination between organizations—rather than competition or siloed service delivery—was essential to sustaining these approaches. Strengthening relationships between hospitals, community clinics, harm reduction services, and peer-led organizations was repeatedly identified as a priority for improving continuity of care.
Turning insight into action
A key outcome of the group work was the development of 6‑month action plans grounded in feasibility rather than aspiration. Participants mapped out clear actions, assigned responsibility, and identified simple metrics to track progress. Common priorities included shifting tasks appropriately within teams (for example, enabling registered nurses to take a greater role in delivering results), reducing dependence on fragmented assistance programs by moving toward “one-stop shop” models, and embedding routine monitoring to assess whether changes are actually improving outcomes.
Training and capacity-building initiatives like this symposium are critical to closing the gap between what we know works and what is happening on the ground. Scaling up effective, community‑based models of care across the U.S. is essential if we are serious about meeting hepatitis C elimination targets. That means investing not only in clinical tools, but in the workforce, partnerships, and policy environments that allow those tools to be used equitably and at scale.
Beyond programmatic changes, discussions also highlighted a growing recognition of the need for coordinated advocacy. Participants noted that many barriers—particularly those related to Medicaid policy, reimbursement structures, and scope-of-practice regulations—cannot be addressed at the service level alone. The symposium created space for shared problem recognition and strengthened commitment to ongoing dialogue and collective advocacy to support policy environments that enable timely, equitable access to HCV care.
A shared commitment to progress
The symposium was moderated by Lindsey Hiebert-Suwondo, Deputy Director at The Coalition for Global Hepatitis Elimination, one of INHSU’s program partners, who framed the day within the broader elimination agenda while emphasizing the centrality of local action.
Hepatitis C elimination will only be achieved if our systems are designed to work for the people most affected. The ideas generated today—around peer support, navigation, and reducing administrative burden—demonstrate what’s possible when collaboration and equity are at the centre of care.
Strengthening a local Community of Practice
By the end of the day, participants had not only deepened their understanding of effective HCV interventions, but also strengthened connections across programs, sectors, and state lines. The participation of attendees from outside Ohio reinforced the shared challenges faced across the region and the value of cross-jurisdiction learning and collaboration.
As part of the broader HCV Intervention Symposia Series, the Cleveland event underscored INHSU’s commitment to supporting locally led, evidence-informed action. While national and global elimination targets offer a shared destination, the work in Cleveland highlighted that progress depends on sustained collaboration, adaptive models of care, and continued investment in the people and systems delivering care on the ground.
