11 December 2024
Hepatitis C elimination remains a critical public health goal in the United States (US), yet the path forward is fraught with challenges. Complex financing structures, convoluted insurance mechanisms, and gaps in reimbursement policies continue to hinder efforts to scale up testing and treatment. Against this backdrop, INHSU has delivered its Hepatitis C Intervention Symposia series over the past two years, striving to equip health professionals with the knowledge, tools and collaborative networks needed to scale up models of care for hepatitis C and drive change.
In 2024, INHSU delivered a series of five symposia across the U.S. Held in Texas, New York City, Portland, San Diego and Atlanta, these events brought together 231 participants from diverse fields, including harm reduction, public health, and policymaking, to address barriers and share strategies for expanding hepatitis C services.
Contextualising the program: challenges in elimination
The US has seen remarkable advances in hepatitis C treatments, but systemic issues limit access for many who need care most. Barriers include:
- Complicated financing: Funding for testing and treatment often falls short, with harm reduction and other community-based programs relying on piecemeal grants rather than consistent public investment.
- Insurance barriers: High rates of uninsured individuals, coupled with restrictive insurance requirements for treatment approval, create hurdles for patients and providers alike
- Reimbursement complexities: Reimbursement models frequently fail to support comprehensive care, including outreach, bundled testing, and long-term patient engagement
INHSU’s symposia provided a vital forum for addressing these issues head-on, equipping participants to navigate and improve their service delivery within this challenging landscape.
Empowering professionals through knowledge and connection
The symposia achieved strong outcomes, with evaluation data collected to date demonstrating that over 92% of participants reported that learning objectives were fully or mostly met. Nearly 89% noted that the knowledge gained would influence their practice, while 91% highlighted the value of new professional connections formed during the events.
Participants expressed a desire to further practical interventions like financial incentives, medical chart reminders, and bundled lab testing in future Symposia to be delivered in 2025.
Lessons from the field
Discussions during the symposia revealed innovative approaches as well as entrenched barriers:
What’s working:
- Community trust: Peer workers played a critical role in engaging people who use drugs, building trust, and facilitating testing and treatment
- Integrated care: Drop-in centres that meet basic needs alongside medical services were essential for reaching underserved populations
- Outreach models: Mobile outreach models of hepatitis C care showcase the power of bringing care to the communities that require it and the power and impact of targeted interventions designed for people who use drugs
Persistent challenges:
- Structural disruptions: Frequent sweeps, forcibly clearing encampments or areas where people experiencing homelessness reside, displace vulnerable populations, making it nearly impossible to ensure medication adherence or follow-up care
- Underfunding: Chronic resource shortages force services to make trade-offs and cut funding to programs
- Insurance barriers: Bureaucratic obstacles, including pre-authorization requirements and coverage gaps, kept many patients from accessing treatment
Pathways to overcoming barriers
To address these challenges, symposium participants identified several actionable solutions:
- Streamline prior authorisation processes: Advocate for simplified insurance procedures to reduce delays in accessing hepatitis C medications
- Develop peer-led outreach Pprograms: Employ and train more individuals with lived experience to engage communities and promote trust in healthcare services
- Utilise the recently FDA-Approved GeneXpert HCV Point-of-Care RNA Test: Integrate this assay into harm reduction programs, mobile clinics, and community health settings to provide a ‘test and treat’ approach to HCV infection. This approach can reduce the need for multiple visits, which can be a barrier for individuals facing housing instability or other challenges, and facilitates streamlined linkage to care and treatment
- Create mobile health units: Deploy mobile clinics to reach underserved populations, especially those impacted by frequent displacement
- Establish multisector partnerships: Collaborate with housing, legal aid, and employment services to address social determinants of health that impact hepatitis C care
- Advocate for policy changes: Particularly to streamline Medi-Cal and other insurance enrolments, making treatment more accessible
Measuring success in new ways
Traditional metrics at a service level, such as treatment completion rates, remain vital, but the symposia also emphasised less conventional measures of success. These included the establishment of hepatitis C-specific spaces within harm reduction networks, increased participant retention within programs, and small victories like overcoming barriers to care for even a few individuals.
Building momentum for elimination
INHSU’s 2024 symposia demonstrated how targeted education, community engagement, and collaborative problem-solving can drive progress in the face of significant barriers.
The road to elimination in the United States remains long, but programs like INHSU’s symposia shine a light on the way forward—through connection, collaboration, innovation, and relentless commitment.
