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)


Last update: 
Reviewed September 2017