Table 1.

Examining the HCV Cascade of Care Through a Problem-Based Lens

Screening:		Linkage to care:		Treatment:
Barriers	Examples of solutions	Barriers	Examples of solutions	Barriers	Examples of solutions
Knowledge of guidelines	Short course learning (online or in-person), integrate into trainee education	Referral to specialist	Co-localize diagnosis and treatment in primary care	Financial burden	Focus policy changes to cover HCV treatment to prevent long-term liver disease, utilize generics to decrease costs
Patient not screened	Increase EMR-based reminders, increase education, utilize “opt-out” screening, utilize POC testing	Patient not interested in treatment	Increase public health awareness, educate in clinic and at health fairs	Difficulty in accessing treatment	Train non-specialists to treat HCV, decrease patient and provider restrictions for HCV treatment, decrease transportation needs, use of telemedicine platforms to access patients
Patients not getting confirmatory test (HCV viral load)	Reflex testing of antibody-positive results, EMR-based reminders	Patient ineligible for treatment per state guidelines	Advocacy to remove all HCV treatment restrictions	Gaps in treatment course or failure to complete course of treatment	Dispense full course of medication at onset of treatment, engagement of pharmacists as treatment partners, patient reminders
Patient not presenting to primary care setting	Take testing to populations most at risk for HCV and those who are unlikely to present to primary care provider			Loss to follow-up or missed appointments	Decrease amount of surveillance labs and office visits to reduce patient visit burden and cost