Hepatitis C Micro‐Elimination Through Patient Navigation of Individuals Experiencing Elevated Risk in a Mid‐Atlantic Regional Healthcare System in 2022 and 2023: A Cohort Study

ABSTRACT Background and Aims Hepatitis C virus (HCV) disproportionately impacts persons with substance use and mental health disorders. Micro‐elimination projects selectively foster diagnosis, treatment and reinfection of high priority demographic groups. A small‐scale, peer navigation focused micro‐elimination project was launched at a regional multidisciplinary and multispecialty health system in the Mid‐Atlantic to facilitate treatment engagement for high‐risk individuals. Methods The program used electronic medical record (EMR) periodic surveillance and navigation of individuals diagnosed with HCV and either not engaged, or not completed, treatment, as well as those needing additional testing (for either sustained virologic response or high‐risk re‐testing). Specialist appointments and referrals for associated behavioral health interventions were provided. Historical propensity score matched controls were utilized to provide a comparator population. Results Between April 2022 and July 2023, 115 persons were navigated, including 78 persons without a prior specialist appointment (New Patients), 15 persons previously engaged with a specialist but not completing treatment, and 22 patients needing additional testing. Among New Patients, 52.6% of patients attended treatment appointments, 28.2% started treatment, and 14.1% had a confirmed undetectable HCV test. Compared to historical matched controls, persons navigated were almost twice as likely to attend an appointment (HR: 1.96 [1.18–3.23], p = 0.008), and nearly three times more likely to start treatment (HR: 2.86 [1.41–5.79], p = 0.003). The median time from navigation to an appointment for New Patients was 71 days, and 143 days until starting treatment. Conclusions A small‐scale, peer‐navigation focused micro‐navigation program successfully engaged patients but had mixed success in successfully navigating the care cascade. Despite navigation and consistent engagement, nearly half of patients dropped off at each step of the care cascade. Compared to historical controls, patients were more likely to make appointments and initiate treatment. Future efforts should be targeted at reducing times for specialist appointments and expanding treatment at diagnosis location.