Theme: Social Science & Policy Research Year: 2022
Background:
People who inject drugs (PWID) are the primary drivers of hepatitis C (HCV) transmission, yet most in
rural and urban South Carolina (SC) have limited access to HCV treatment. New models of care are
needed to address the needs of populations with limited access to HCV treatment. This project is a
collaboration between nurse practitioner (NP) led mobile health units (MHUs), a large healthcare
system, and community-based organizations (CBOs) to diagnose and treat HCV in rural, substance use
and/or homeless populations.
Methods:
A team of NPs working out of MHUs identify and partner with CBOS (e.g.,, methadone, substance use,
food insecurity and homeless programs) who serve clients in need of HCV treatment. The team provides
point-of-care (POC) HCV Antibody (Ab) screening; in-person and telehealth HCV evaluation and
treatment; and care coordination.
Results:
Overall, 325 were screened, 85 were HCV Ab+ and 22 initiated direct-acting antiviral (DAA) treatment.
Patient characteristics: mean age 49; 50% male; 60% white; 25% history of injection drug use. Many
treatment initiation barriers were identified: HCV- and Medicaid-related stigma; low HCV education; lack
of POC viral load; excessive paperwork; poor access to syringe service programs (SSPs), medications for
opioid use disorder (MOUD), transportation, and broadband; payers restrictions and requirements;
complex coordination with payers, labs, and pharmacies; and lack of Medicaid expansion.
Conclusion:
NP-led MHUs are a promising approach for HCV treatment in SC. However, patient, provider and health
system-level barriers must be overcome in order to eliminate HCV. Approval of POC viral load tests;
ability to dispense complete DAA course; legalization of SSPs ; increased availability of MOUD, peers and
care coordinators; and improved transportation and broadband access are urgently needed. Next steps
include offering HIV PrEP and MOUD at MHUs and ensuring that opioid settlement dollars are directed
towards HCV elimination.
Disclosure of Interest Statement:
No potential competing interests were reported by the authors.