Advancing Hepatitis C Elimination: A Coordinated Public Health and Health Care Strategy

Millions of Americans suffer from chronic hepatitis C, which remains the leading cause of liver cancer and liver transplantation, despite the availability of diagnostic tests and curative therapies. The Biden Administration has proposed a national program for hepatitis C elimination that prioritizes the development of point of care diagnostics, broad access to curative DAA therapy , and comprehensive and coordinated efforts across public health and health care programs to engage, inform, identify, and treat individuals with hepatitis C. Consequently, there is unprecedented interest in developing a feasible implementation pathway to ensure maximum impact of new federal investments needed to implement such a program. This policy brief outlines recommendations for an implementation strategy for this national program.

Although most people with hepatitis C have Medicaid or Medicare insurance, many of these patients as well as uninsured Americans with hepatitis C have been underserved by the nation’s existing health care infrastructure. Thus, an implementation strategy should include mechanisms to both reach patients and promote continuity of treatment through accountable test-to-treat pathways. Hepatitis C treatment programs have traditionally been implemented through public health organizations including the CDC, state, and local health departments. However, most Americans with hepatitis C receive care through health care programs supported by Medicare and Medicaid. Promising programs to inform a national initiative have also been implemented through health care programs, including certain state Medicaid plans, notable tribal programs, and the Veterans Administration. Additionally, learnings from the COVID-19 pandemic national response, which implemented test-to-treat and vaccination strategies across all traditional and non-traditional sties of care, can also advance hepatitis C test to treat approaches. Finally, the national program can benefit from medical progress that has made it feasible for primary care practices – including safety-net providers – to oversee the full scope of screening, testing, treatment, and prevention in the populations they serve. National progress in provider payment and care delivery reforms that support more effective collaboration between health care, public health, and other public and private community resources can increase the adoption of capabilities to identify, screen and treat hepatitis C – creating a more robust, permanent capacity to prevent and manage hepatitis C for the future.

In collaboration with stakeholders and experts, the Duke-Margolis Institute developed a strategic framework for a national hepatitis C elimination program with the goal of informing an implementation pathway for the Administration’s proposal. The framework reflected learnings from a broad range of successful local and regional programs as described above, including “test to treat” initiatives embedded in community based primary care models; effective management of COVID-19 and other respiratory pathogens resulting from improved diagnostic technologies and public health analytics; and provider payment reforms with greater accountability for important population health outcomes.

Read the full brief here.