The hepatitis C virus (HCV) is a significant cause of liver disease, yet many people who are infected remain asymptomatic for years. While effective treatments can cure the infection, fewer than one in three diagnosed patients in Los Angeles County complete their care.

Project HCV Connect is targeting the problem by training University of Southern California (USC) healthcare students as caseworkers. These students reach out to infected individuals and connect or reconnect them with healthcare providers.

“Our caseworkers call patients and tell them, ‘You have hepatitis C, it’s treatable and we can offer some options,’” said Chrysovalantis Stafylis, MD, MPH, first author and a senior research associate at the Keck School of Medicine of USC. “Patients are guided to connect with their primary care doctor—or if they don’t have one, caseworkers can link them to community clinics or telemedicine partners who can provide treatment.”

The overarching goal of Project HCV Connect is to build a scalable public health infrastructure across the county to close treatment gaps and support the elimination of hepatitis C.

Project HCV Connect was partially supported by a multidisciplinary grant from the Southern California Clinical and Translational Science Institute (SC CTSI). The project is a collaborative effort between the Los Angeles County Department of Public Health (LACDPH) and USC. It leverages public health case reports and caseworker interviews to pinpoint barriers and support systems related to hepatitis C testing, treatment initiation, and completion.

The team is led by principal investigator and lead author Jeffrey Klausner, MD, MPH, Clinical Professor of Medicine, Infectious Diseases, Population, and Public Health Sciences at the Keck School of Medicine at USC. They published a project report in the Journal of Public Health Management & Practice.

The authors noted that some patients infected with HCV grapple with substance use, mental illness or homelessness. Without caseworkers to track and encourage individuals to seek care, many patients fall through the cracks in a broken system. For instance, positive HCV test results are reported to public health registries. But registries are generally passive collectors of information and lack the resources to follow up with infected individuals who still need treatment.

The project recruits USC students from medicine, public health, global health and health promotion programs to work as caseworkers.

“We are leveraging a very underutilized workforce that wants real-life work experience, and this helps prepare the next generation of public health workers,” Stafylis said. “One of the lessons of the COVID pandemic is that we can train students on important public health tasks.”

Caseworkers ask HCV patients about their insurance status and any obstacles in starting or completing treatment. Patients are informed that current HCV regimens are relatively easy to manage, typically consisting of 8 to 12 weeks of oral treatment with limited monitoring. The HIPAA-trained caseworkers also help schedule appointments with healthcare providers. If patients lack regular providers, they connect patients with partnering treatment programs.

Three months after the initial contact, caseworkers follow up with calls to further support patients and update their treatment status in the HCV project management database.

A SC CTSI-funded sub-study of Project HCV Connect found that infected people in their 30s and early 40s were nearly three times more likely to finish hepatitis C treatment than those in their late teens and 20s. Younger adults may be less informed about the disease and more likely to be dealing with active substance use and other life pressures, according to co-author Stafylis. The sub-study appeared in BMC Infectious Diseases.

Patients tested and treated by liver or infectious disease specialists were almost twice as likely to complete treatment as those seen only in primary care. Specialists have greater familiarity with hepatitis C and have more time and support to help manage the disease. The authors noted that expanding primary care physicians’ capacity to treat hepatitis C directly, rather than just testing and referring, could significantly improve treatment completion.

Another SC CTSI-funded sub-study was led by Daniel Soto, Ed.D, MPH, Assistant Professor at the Keck School of Medicine of USC and Director of the Center for Population Health. Soto and his team are completing in-depth interviews with patients, providers, and community navigators (promotores de salud) to understand why some people with hepatitis C start and complete treatment, and why others never do.

“If we’re serious about making Los Angeles County hepatitis C–free, we have to look beyond the lab results and listen to people’s lived realities—how they move through clinics, jails, families and neighborhoods—and then design interventions that meet them where they are,” Soto said.