• J Gen Intern Med · Feb 2025

    Building a Low-Threshold Model for HCV Diagnosis and Treatment Among Formerly Incarcerated Patients in Alabama.

    • Margaret Hayden, Sanjay Kishore, Davis Bradford, Mikaela Dedona, Meghan Hunter, Mary Ellen Luck, and Ryan Pratt.
    • University of Virginia Medical Center: UVA Health University Hospital, Charlottesville, VA, USA. margaret.hayden@uvahealth.org.
    • J Gen Intern Med. 2025 Feb 12.

    BackgroundMillions of Americans remain infected with hepatitis C (HCV). Innovation in care delivery is required to achieve the goal of national elimination.AimDevelop a low-threshold HCV treatment program.SettingFree clinic with mobile unit providing transitional care to people leaving jails and prisons across Alabama.ParticipantsFormerly incarcerated persons, many of whom are uninsured and live in rural areas.Program DescriptionWe utilized point-of-care diagnostics to condense the HCV screening and pre-treatment evaluation into a single encounter. Patient assistance programs were used to obtain medications for uninsured patients. Clinical support was provided through in-person and telehealth care.Program EvaluationFrom January 2023 to December 2024, 369 patients were screened for HCV; 104 (28.1%) were HCV antibody positive, and 71 (19.2%) were viremic. Of these patients, 70 completed pre-treatment diagnostics, 54 started treatment, 41 confirmed completion, 20 had SVR12 collected, with 19 achieving cure (94% cure rate). The median time from diagnosis to treatment initiation was 27 days.DiscussionIt is possible to both diagnose HCV and complete the entire pre-treatment evaluation in a single encounter and initiate treatment within 1 month, even for predominantly uninsured populations in rural areas.© 2025. The Author(s).

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