Providers' Perspectives on Implementation of Low-threshold HCV Treatment in New York State: A Qualitative Study

Abstract

Background: Global study data show injection drug use is driving upwards of 79% of all new hepatitis C virus (HCV) cases in high-income countries. Low-threshold models can engage vulnerable populations in treatment to achieve HCV elimination targets. We examined the implementation of low-threshold models for HCV care in New York State, which has a robust HCV elimination program.

Methods: We conducted semi-structured interviews with 16 healthcare providers in 2022. Included providers either self-described as "low-threshold," had a clinical focus on marginalized populations, or practiced in non-traditional settings. Interviews focused on the implementation of low-threshold HCV care. Transcripts were analyzed using thematic analysis and were categorized into themes guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.

Results: Providers implemented low-threshold HCV care by facilitating access (e.g., having walk-in or telemedicine HCV services). Point-of-care testing and peer support were other important features. The inner context was driven by provider and organization values and involved providing low-threshold HCV care within health systems that were not themselves "low-threshold." Adequate staffing was crucial for the extensive care coordination and outreach activities needed to engage persons who inject drugs (PWID). The outer context was characterized by a limited funding environment, restrictive insurance policies, and the high impact of patients' unmet social needs. Providers relied on care coordination and integrated care models to overcome these barriers.

Conclusions: Low-threshold HCV care incorporates operational flexibility and patient navigation but is challenged by patients' unmet social needs. Jurisdictions can support implementation by providing adequate funding for substantial outreach activities needed to engage vulnerable populations.

Keywords: hepatitis C; implementation; injection drug use; qualitative; substance use disorder.

Graphical Abstract

Figure 1.

EPIS framework for low-threshold HCV care programs. Abbreviations: EPIS, Exploration, Preparation, Implementation, Sustainment; HCV, hepatitis C virus.