Implementing a Social Work-Led Hepatitis C Treatment Model for Individuals with Substance Use Disorders in Primary Care.

Objective: This study examined a social work-led, treatment-first model for hepatitis C virus (HCV) treatment embedded in an integrated primary care clinic serving individuals with substance use disorders (SUDs). This approach affirms the critical role of social workers in leading integrated HCV treatment models that expand access and improve outcomes for people with SUDs.

Methods: We conducted a retrospective cohort evaluation of patients with confirmed HCV seen between 2018 and 2021. Eligible participants were identified through psychiatric and SUD programs, community referrals, and primary care. Individuals medically appropriate for treatment in primary care were offered direct-acting antivirals regardless of substance use or social circumstances. A licensed clinical social worker coordinated treatment, harm reduction counseling, social determinants of health screening, and care navigation. Electronic health record data were analyzed using descriptive and bivariate statistics (χ² tests, t-tests) to compare treatment initiation and sustained virologic response (SVR12) outcomes across demographic and SUD subgroups.

Results: Of 190 individuals diagnosed with HCV, 88 (46.3%) initiated treatment and 75 (85.2%) achieved SVR12. All treated patients received three core social work services and received a mean of seven social work encounters. Cure rates were consistent across SUD subgroups. However, individuals with stimulant (p < .03) or sedative-hypnotic use disorders (p < .003) were significantly less likely to initiate treatment.

Conclusions: Social workers can effectively lead HCV treatment within integrated primary care. Treatment-first, harm reduction - oriented models address structural barriers, expand access, and achieve high cure rates for populations historically excluded from specialty-based or abstinence-based care.