201. Large Scale Implementation of Opportunistic HCV Treatment during Hospitalization in a US Tertiary Care Hospital

TL;DR

A hospital-based program successfully treated hepatitis C in underserved patients by starting treatment during hospital stays.

Contribution

A novel inpatient HCV treatment protocol using navigators to overcome barriers for marginalized populations.

Findings

174 patients initiated HCV treatment during hospitalization.

76% of patients achieved sustained virologic response or completed treatment.

The approach successfully engaged patients less likely to attend outpatient care.

Abstract

Hepatitis C virus (HCV) remains a leading cause of liver-related morbidity and mortality. Despite effective treatment with direct-acting antivirals (DAAs), many individuals remain untreated due to systemic barriers. Hospitalization offers a “reachable moment” to initiate HCV care, particularly for underserved populations. We present the preliminary findings from a navigator-supported opportunistic HCV treatment protocol initiated during admission to a US tertiary care hospital.

Navigators included a case manager and nurse navigator who assisted with review of inpatients with detectable HCV RNA, provided education, verified insurance coverage, and referred eligible patients for infectious diseases consultation. Consultations were billed to primary payors. DAAs were prescribed during hospitalization via outpatient specialty pharmacies. Medications were delivered bedside at the time of discharge when feasible. Priority populations included individuals with transportation barriers, prior missed outpatient appointments, discharges to supervised settings, people who use drugs, and postpartum women.

174 people initiated DAA therapy through the opportunistic treatment protocol. To date, 136 patients were due for sustained virologic response (SVR) labs among whom 76% were known to have achieved SVR and/or treatment completion. The remaining individuals are still completing treatment or not yet due for SVR labs.

This strategy successfully engaged patients traditionally less likely to attend outpatient care, leveraging inpatient infrastructure to remove common barriers to treatment initiation. Inpatient and discharge-based HCV treatment can be a successful strategy to expand access to HCV treatment for marginalized populations. This approach, centered on multidisciplinary coordination and targeted patient engagement, demonstrates meaningful real-world feasibility. Broad implementation will require institutional investment towards dedicated personnel and processes to support identification, education, and linkage to care.

All Authors: No reported disclosures