Community-based interventions to improve hepatitis C linkage to care among people with substance use disorders in Southwest Virginia: a pragmatic sequential cohort study.

In 2024, the reported hepatitis C virus (HCV) case rate in Roanoke City was nearly three times the rate of the state of Virginia, reflecting the disproportionate impact of the opioid epidemic in the region. Despite highly effective direct-acting antiviral therapies, substantial barriers to linkage to care (LTC) persist among individuals with substance use disorders (SUDs). While prior studies suggest that patient navigation and financial support may improve LTC, evidence from rural and underserved settings remains limited. This study aims to evaluate community-based interventions designed to improve HCV LTC among individuals with SUD in Southwest Virginia. We conducted a pragmatic, non-randomized, sequential cohort pilot study to evaluate the impact of iteratively refined community-based interventions on LTC. A total of 60 adults with detectable HCV RNA and SUD were enrolled sequentially into four cohorts (control and three intervention groups). All participants received peer support; intervention components were modified across cohorts to address observed barriers to care. The primary outcome was attendance at an outpatient HCV visit within 180 days of enrolment. LTC was 3/15 (20%) in both the control group and Intervention 1, increasing to 6/15 (40%) in Intervention 2 and 11/15 (73%) in Intervention 3. Exploratory analyses demonstrated significantly higher attendance in Intervention 3 than in the control group (73% vs. 20%, P = .009). Telehealth utilization and provision of prepaid phones were incorporated in the final cohort, which demonstrated the highest LTC rate. Multicomponent community-based interventions were associated with improved LTC among individuals with SUD. Although the non-randomized sequential design limits causal attribution, the progressive improvement across cohorts provides preliminary support for a potential benefit. Interventions incorporating community navigation, telehealth access, and communication support may help address barriers to HCV treatment engagement in underserved communities.