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

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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)



Reviewed June 2016.