Enhancing the Hepatitis C Cascade of Care: Implementation Science Approach in a Federally Qualified Health Center System

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Abstract
Context: Hepatitis C virus (HCV) remains a significant public health challenge in the United States, particularly among underserved populations. Despite curative treatments, systemic barriers often delay the care cascade. Program: This quality improvement program aimed at improving the care of patients with chronic Hepatitis C within a Federally Qualified Health Center system in Southern California, known as AltaMed Health Services. The program involves AltaMed, serving more than 700 000 patients, primarily low-income people in underserved communities through an integrated delivery system for Latino and multiethnic individuals, focusing on enhancing screening and treatment processes for Hepatitis C. Methods: A multipronged clinical workflow redesign was evaluated utilizing the RE-AIM framework to assess process and clinical between 2022 and 2024. Intervention included an electronic health record (EHR) Best Practice Advisory to identify patients due for HCV screening, a standardized direct-referral workflow, and a Linkage to Care team to manage prior authorization administrative tasks and patient outreach efforts. Evaluation: Total descriptive HCV screening volumes increased from 30 212 to 47 951, with screening rates expanding from 3.4% to 7.3% in nonspecialty clinics. Treatment initiation rates shifted from 36% to 45%, and post-treatment patient outreach documentation changed from 48% to 73%. The average duration from diagnosis to treatment initiation was observed to be 55.9% lower, changing from 34 weeks in 2022 and 15 weeks in 2024. Discussion: Establishing an Linkage to Care team, combined with automated EHR tools, can track alongside meaningful improvements in the safety-net HCV care cascade. Scaling models require careful consideration of specialized staffing and localized EHR infrastructure to advance health equity and global HCV elimination goals.

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