Advancing Hepatitis C Elimination

Advancing Hepatitis C Elimination

Project Highlights

Despite the availability of multiple curative treatments since 2013, the incidence of hepatitis C increased by 71% between 2014 and 2018.

Efforts to reduce treatment cost and broaden access through payment mechanisms alone have not been sufficient to tackle hepatitis C. A multifaceted approach incorporating improved surveillance, provider training, patient identification, and care management in addition to DAA access will be required to successfully contain and eliminate hepatitis C.

Since 2022, Duke-Margolis has worked to develop a curative, evidence, and context-based implementation pathway for a national hepatitis C elimination strategy, informed by discussions and collaboration with key stakeholders and experts.



Hepatitis C is a bloodborne liver infection caused by the hepatitis C virus (HCV). In 2013, the FDA approved the first direct-acting antiviral (DAA), a novel class of drugs that inhibit viral protein synthesis and prevent hepatitis C replication. Multiple DAA treatment options have since become available that can cure hepatitis C in over 90% of cases. In recent years, testing technologies have also improved, including the development of point-of-care viral RNA tests (not yet authorized in the United States). These new testing technologies have the ability to support streamlined care delivery by limiting the number of drop-off points and reducing patient attrition rates and “reflex” testing needs through combining antibody and viral detection testing. Additionally, increased access to telehealth services and adoption of best practices can enable primary care teams and clinics to oversee treatment administration for many patients. 
Despite the availability of curative hepatitis C therapies and modes for more convenient and integrated testing and treatment, millions of Americans remain infected, with prevalence rates increasing in some populations. A disproportionate burden of HCV exists among Medicaid beneficiaries, incarcerated individuals, individuals who use intravenous drugs, and those who are uninsured. Within these populations, racial and ethnic disparities persist. The gap between potential elimination and current conditions is the consequence of failures at each step in the hepatitis C care pathway, including affordability of drug therapy as well as access to convenient screening, appropriate prescribing, and treatment monitoring. These failures include not only addressing the expense of such care but also addressing lack of awareness, transportation and scheduling difficulties, lack of access to providers trained in hepatitis C treatment, stigma or discrimination in health care settings, inadequate care for those experiencing substance use disorders, psychiatric illness, or other relevant comorbidities, and housing instability for impacted populations.

Project Overview

Through this research project, Duke-Margolis, in partnership with a range of stakeholders and experts, will develop an evidence-based implementation pathway for a national hepatitis C elimination strategy. This work will build on evidence from past and current implementation activities, particularly previous initiatives undertaken by Louisiana and other states, as well as by CDC, HRSA, and other relevant Federal government bodies actively engaged in serving populations impacted by hepatitis C. We will inform our technical analysis with public and private stakeholder engagement to identify practical obstacles and feasible policy options to overcome them and leverage high policymaker interest and recent developments in drug procurement, surveillance, testing and treatment.


Funding for this project was made possible in part by Arnold Ventures LLC. The views expressed in events, written materials, or publications and by participants do not necessarily reflect the official views not endorsement by Arnold Ventures LLC. 

Duke-Margolis Project Team


Beena Bhuiyan Khan, MSc

Research Director for Payment and Coverage Policy

Christina Bush Headshot

Christina Bush, MPH

Policy Analyst

Hannah Graunke Headshot

Hannah Graunke, MPP

Senior Policy Analyst


Marianne Hamilton Lopez, PhD, MPA

Senior Research Director, Biomedical Innovation
Faculty Director of the Duke-Margolis Postdoctoral Associates & Affiliated Fellows Program
Adjunct Associate Professor
Senior Team Member
Margolis Core Faculty

Mark McClellan

Mark McClellan, MD, PhD

Director of the Duke-Margolis Institute for Health Policy
Robert J. Margolis, MD, Professor of Business, Medicine and Policy
Margolis Executive Core Faculty