Finbråten Ane-Kristine, Chin Cristina L, Seetharaman Meenakshi, Hutchings Kayla, Eckhardt Benjamin J, Schackman Bruce R, Kapadia Shashi N
Department of Population Health Sciences, Weill Cornell Medicine, New York New York, USA.
Harkness Fellowship in Healthcare Policy and Practice, Commonwealth Fund, New York New York, USA.
Open Forum Infect Dis. 2025 Mar 26;12(4):ofaf184. doi: 10.1093/ofid/ofaf184. eCollection 2025 Apr.
Global study data show injection drug use is driving upwards of 79% of all new hepatitis C virus (HCV) cases in high-income countries. Low-threshold models can engage vulnerable populations in treatment to achieve HCV elimination targets. We examined the implementation of low-threshold models for HCV care in New York State, which has a robust HCV elimination program.
We conducted semi-structured interviews with 16 healthcare providers in 2022. Included providers either self-described as "low-threshold," had a clinical focus on marginalized populations, or practiced in non-traditional settings. Interviews focused on the implementation of low-threshold HCV care. Transcripts were analyzed using thematic analysis and were categorized into themes guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
Providers implemented low-threshold HCV care by facilitating access (e.g., having walk-in or telemedicine HCV services). Point-of-care testing and peer support were other important features. The inner context was driven by provider and organization values and involved providing low-threshold HCV care within health systems that were not themselves "low-threshold." Adequate staffing was crucial for the extensive care coordination and outreach activities needed to engage persons who inject drugs (PWID). The outer context was characterized by a limited funding environment, restrictive insurance policies, and the high impact of patients' unmet social needs. Providers relied on care coordination and integrated care models to overcome these barriers.
Low-threshold HCV care incorporates operational flexibility and patient navigation but is challenged by patients' unmet social needs. Jurisdictions can support implementation by providing adequate funding for substantial outreach activities needed to engage vulnerable populations.
全球研究数据显示，在高收入国家，注射吸毒导致了超过79%的新增丙型肝炎病毒（HCV）病例。低门槛模式可以让弱势群体参与治疗，以实现消除HCV的目标。我们研究了纽约州HCV护理低门槛模式的实施情况，该州有一个强有力的HCV消除计划。
2022年，我们对16名医疗服务提供者进行了半结构化访谈。纳入的提供者要么自我描述为“低门槛”，要么临床重点关注边缘化人群，要么在非传统环境中执业。访谈重点是低门槛HCV护理的实施情况。使用主题分析法对访谈记录进行分析，并根据探索、准备、实施、维持（EPIS）框架将其归类为主题。
提供者通过便利就诊（如提供无需预约或远程医疗的HCV服务）来实施低门槛HCV护理。即时检测和同伴支持是其他重要特征。内部环境受提供者和组织价值观驱动，涉及在本身并非“低门槛”的卫生系统内提供低门槛HCV护理。充足的人员配备对于吸引注射吸毒者（PWID）参与所需的广泛护理协调和外展活动至关重要。外部环境的特点是资金环境有限、保险政策受限以及患者未得到满足的社会需求影响很大。提供者依靠护理协调和综合护理模式来克服这些障碍。
低门槛HCV护理具有操作灵活性和患者导航功能，但受到患者未得到满足的社会需求的挑战。司法管辖区可以通过为吸引弱势群体参与所需的大量外展活动提供充足资金来支持实施。
