Reduction in Hepatitis C Virus RNA Positivity Among Clients in an Inpatient Substance Use Treatment Program in New York City

The New York State Hepatitis C Elimination Plan ¹ identifies people who use drugs as a top-priority population and substance use treatment programs as an important setting for intervention. Both priorities align with the New York City Plan to Eliminate Viral Hepatitis by 2030, which emphasizes integrated care and prevention strategies across communities at high risk of hepatitis C virus (HCV) reinfection. ² While New York State holds an A+ rating for HCV treatment access ³ and New York City has a high number of HCV programs, residential substance use treatment programs remain underused as HCV intervention sites. ⁴ Despite a high prevalence of individuals who are HCV RNA–positive in these settings, compared with the US population estimated prevalence of 1.6% from 2017 through 2020, ⁵ routine testing is uncommon, and few programs provide on-site treatment.

To address this gap, the Viral Hepatitis Program at the New York City Department of Health and Mental Hygiene and the Mount Sinai Hospital Respectful & Equitable Access to Healthcare Program collaborated to improve access to HCV care for people who use drugs via telehealth. In partnership with an inpatient substance use treatment center, universal HCV screening was implemented for all admissions using laboratory HCV antibody testing with automatic reflex to HCV RNA testing. The program successfully screened 7706 of the 8026 nonunique admissions (96.0%) during 4 years (May 2021–April 2025). The HCV antibody–positive rate among those screened was 22.2% (1707 of 7706), and the HCV RNA–positive rate was 7.5% (578 of 7706), 4.7 times higher than in the general population. ⁵ The project goal was to establish the feasibility of providing HCV treatment via a facilitated telehealth-based care model to individuals with HCV RNA–positive test results at the inpatient program. ⁶ Challenges we identified include that many people left in the days after admission before receiving laboratory test results and that the maximum length of stay is only 28 days. Eighty-one of these 1707 people (4.7%) had a telehealth visit, 60 (74.1%) of whom began HCV treatment.

Because a positive HCV antibody test result reflects lifetime exposure to the hepatitis C virus, substantial changes in antibody prevalence were not expected. In line with this expectation, we found that rates of HCV antibody–positive status during the 4 years of study (May 2021–April 2022, May 2022–April 2023, May 2023–April 2024, and May 2024–April 2025) (403 of 1713 [23.5%]; 490 of 2372 [20.7%]; 416 of 1957 [21.3%]; and 398 of 1984 [20.1%], respectively) did not change significantly (P = .16). The proportion of admitted individuals reporting injection drug use during the 4 years (272 of 1713 [15.9%]; 329 of 2372 [13.9%]; 247 of 1957 [12.6%]; and 247 of 1984 [12.4%] during the 4 years, respectively) showed a nonsignificant downward trend (P = .05). In contrast, the proportion of HCV antibody–positive individuals with detectable HCV RNA declined significantly during the 4 years (171 of 403 [42.4%]; 171 of 490 [34.9%]; 129 of 416 [31.0%]; and 107 of 398 [26.9%], respectively; linear regression trend test, β = −5.04 percentage points per year; P = .014), indicating a meaningful reduction in chronic HCV infection in this sampled inpatient population during the 4 years.

Substance use treatment programs provide a unique opportunity to reach individuals at elevated risk for HCV who may not otherwise access testing or care. Integrating routine screening and telehealth treatment into such programs not only improves individual health outcomes but can also reduce community-level transmission among injecting drug users. ⁷ Moreover, because these programs disproportionately serve people experiencing homelessness, people with justice involvement, and people with other structural inequities, HCV care integration provides care to groups of individuals who face multiple barriers to accessing treatment.

To achieve HCV elimination, public health agencies and health insurance payers must prioritize substance use treatment programs as sites for HCV screening, prevention, and intervention. Universal screening and treatment should be the standard of care in these programs. New reimbursement models are needed to support inpatient substance use programs in integrating HCV treatment services, which extend beyond the traditional scope and payment structures designed for substance use disorder care. The sustained decline in HCV RNA prevalence we observed suggests the effectiveness of the HCV treatment models in New York City during these 4 years. The success of this pilot program warrants further expansion and analysis to better understand the effectiveness of the intervention and its potential for broader implementation. Every admission to an inpatient substance use treatment program is an opportunity to prevent or cure HCV—one that we cannot afford to miss.