Testing and Linkage to Care: Table 3 – Common Barriers to HCV Treatment and Potential Strategies

Contraindications to treatment (eg, comorbidities, substance abuse, and psychiatric disorders)

• Counseling and education
• Referral to services (eg, psychiatry and opioid substitution therapy)
• Optimize treatment with simpler and less toxic regimens

Competing priority and loss to follow-up

• Conduct counseling and education
• Engage case managers and patient navigators (HIV model)
• Co-localize services (eg, primary care, medical homes, and drug treatment)

Long treatment duration and adverse effects

• Optimize treatment with simpler and better tolerated regimens
• Education and monitoring
• Directly observed therapy (tuberculosis model)

Lack of access to treatment (high cost, lack of insurance, geographic distance, and lack of availability of specialists)

• Leverage expansion of coverage through the Patient Protection and Affordable Care Act
• Participate in models of care involving close collaboration between primary care practitioners and specialists
• Pharmaceutical patient assistance programs
• Co-localize services (primary care, medical homes, drug treatment)

Lack of practitioner expertise

• Collaboration with specialists (eg, via Project ECHO-like models and telemedicine)
• Develop accessible and clear HCV treatment guidelines
• Develop electronic health record performance measures and clinical decision support tools (eg, pop-up reminders and standing orders)