# Clinical and demographic characteristics of participants in a hepatitis C treatment trial in rural Kentucky: How policies around treatment access may impact elimination efforts in the United States

## TL;DR

This study examines how restrictive Medicaid policies in the US limit access to hepatitis C treatments, especially in rural Kentucky, and how this hampers elimination efforts.

## Contribution

The study highlights how state Medicaid policies restrict HCV treatment access and hinder elimination goals in the US.

## Key findings

- Fewer than one in five participants would be eligible for HCV treatment in states without Medicaid expansion.
- Same-day test and treat models are not possible in almost half of US states due to preauthorization requirements.
- Over 85% of participants started treatment the same day as screening in the KeY Treat study.

## Abstract

The advent of curative direct acting antiviral (DAA) drugs to treat those actively infected with the hepatitis C virus (HCV) has allowed for discussion around HCV elimination. Restrictive state‐by‐state policies for the coverage of DAAs for Medicaid recipients may hamper elimination efforts in the United States by limiting access to these curative treatments.

The purpose of the current analysis was to examine the sociodemographic, drug use and clinical characteristics of participants in the Kentucky Viral Hepatitis C Treatment (KeY Treat) study in the context of Medicaid policies in the United States. The goal of KeY Treat was to reduce barriers to accessing curative DAAs by providing screening and treatment free of charge.

Results suggest that fewer than one in five KeY Treat participants would be eligible for HCV treatment in states without Medicaid expansion. A third of KeY Treat participants were actively injecting drugs and 40% indicated recent drug use, which would negatively impact their ability to easily access treatment in seven US states. More than 85% of KeY Treat participants started treatment the same day as screening. However, same‐day test and treat models would not be possible in almost half of US states because of preauthorization requirements that limit the ability of providers to employ innovative point‐of‐care RNA screening.

As an elimination plan takes shape in the United States, it is clear that it will be necessary to remove all restrictions for accessing treatment to allow for meaningful increases in HCV treatment uptake and cure.