Clinical Scorecard: Initiating Hepatitis C Treatment During Hospital Stays for Individuals Who Use Drugs: A Comprehensive Literature Review
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection
Key Mechanisms
HCV transmission primarily via injection drug use; treatment as prevention reduces transmission and disease burden
Target Population
People who use drugs (PWUD) with history of or active substance use disorder
Care Setting
Hospital inpatient setting with linkage to outpatient care
Key Highlights
Hospitalization offers a critical opportunity to initiate HCV treatment for PWUD who face barriers to outpatient care.
Inpatient HCV treatment models increase treatment initiation and completion compared to standard outpatient referral.
Systemic barriers include insurance challenges, stigma, delayed diagnosis, and lack of integrated services for PWUD.
Guideline-Based Recommendations
Diagnosis
Implement HCV antibody testing followed by confirmatory RNA testing during hospitalization for PWUD.
Management
Initiate HCV treatment during hospital stay to improve linkage and reduce loss to follow-up.
Integrate HCV treatment with addiction, harm reduction, and mental health services.
Monitoring & Follow-up
Confirm treatment completion and laboratory evidence of cure post-therapy.
Provide intensive outreach and transitional care to support adherence and follow-up.
Risks
Be aware of medication procurement challenges due to insurance coverage limitations, especially in non-Medicaid expansion regions.
Address psychosocial complexities that may affect treatment prioritization during acute illness.
Patient & Prescribing Data
Hospitalized adults with history of or active substance use disorder and HCV infection
Inpatient initiation leads to higher rates of treatment initiation and completion compared to outpatient referral, supporting microelimination strategies.
Clinical Best Practices
Use hospitalization as a key moment to engage PWUD in HCV treatment to overcome outpatient care barriers.
Develop multidisciplinary inpatient models including infectious disease, addiction medicine, and social support services.
Address systemic and individual barriers such as stigma, insurance issues, and comorbidities to optimize treatment access.
Leverage telehealth and community-based programs to support continuity of care post-discharge.
by Jacob Denkins, Jane Babiarz, YoungYoon Ham, HaYoung Ryu, Brian Ricci, Carissa Williams, Ian Alexander, Kendall Tucker, L Madeline McCrary, Ximena Levander
