Initiating Hepatitis C Treatment During Hospital Stays for People Who Use Drugs

Overview

Hospitalization offers a critical opportunity to initiate hepatitis C virus (HCV) treatment among people who use drugs (PWUD), a population with high HCV incidence and barriers to outpatient care. Evidence from six studies across four countries indicates that inpatient HCV treatment models improve treatment initiation and completion rates compared to standard outpatient referral.

Background

Hepatitis C virus infection disproportionately affects PWUD, who contribute to nearly half of global new infections. Traditional outpatient HCV treatment models involve multiple steps and face significant barriers for PWUD, including stigma, insurance challenges, and complex psychosocial needs. Hospitalization is increasingly recognized as a strategic setting to engage PWUD in HCV care, potentially overcoming outpatient follow-up gaps. Innovative inpatient treatment models, integrated with addiction and mental health services, may accelerate progress toward global HCV elimination goals.

Data Highlights

Review included 6 peer-reviewed studies from 4 countries published between 2014 and 2024. These studies demonstrated higher rates of HCV treatment initiation and completion when treatment was started during hospitalization compared to outpatient referral. Cost analyses suggest expanding HCV treatment among publicly insured populations could yield substantial long-term healthcare savings, exceeding $49 billion nationally over 10 years in the US.

Key Findings

• PWUD face multiple systemic and psychosocial barriers to outpatient HCV treatment, including stigma, insurance restrictions, and lack of integrated care.
• Hospitalization provides a unique opportunity to initiate HCV treatment for PWUD who might otherwise be lost to follow-up.
• Inpatient HCV treatment models with intensive outreach and linkage to addiction services increase treatment initiation and completion rates.
• Delays in diagnosis and treatment due to traditional two-step testing and insurance prior authorizations hinder timely care.
• Treatment as prevention among PWUD reduces HCV transmission and supports microelimination strategies.
• Challenges to inpatient treatment include medication procurement and competing patient priorities during acute illness recovery.

Clinical Implications

Clinicians should consider initiating HCV treatment during hospital stays for PWUD to improve engagement and outcomes. Integrating HCV care with addiction and mental health services in inpatient settings can address barriers and facilitate continuity of care. Policymakers and healthcare systems should support inpatient treatment models and streamline medication access to advance HCV elimination efforts.

Conclusion

Hospital-based HCV treatment for PWUD is a promising strategy to overcome outpatient care barriers and enhance treatment uptake. Incorporating inpatient initiation into comprehensive elimination plans is essential to reduce HCV burden among this vulnerable population.

References

1. Viral Hepatitis National Strategic Plan and WHO 2030 Global Elimination Goals
2. Cost Analysis of Expanding HCV Treatment in the US
3. Studies on Treatment as Prevention for HCV Among PWUD