Abstract
Introduction: The advent of curative direct acting antiviral (DAA) drugs to treat those actively infected with the hepatitis C virus (HCV) has allowed for discussion around HCV elimination. Restrictive state-by-state policies for the coverage of DAAs for Medicaid recipients may hamper elimination efforts in the United States by limiting access to these curative treatments. Methods: The purpose of the current analysis was to examine the sociodemographic, drug use and clinical characteristics of participants in the Kentucky Viral Hepatitis C Treatment (KeY Treat) study in the context of Medicaid policies in the United States. The goal of KeY Treat was to reduce barriers to accessing curative DAAs by providing screening and treatment free of charge. Results: Results suggest that fewer than one in five KeY Treat participants would be eligible for HCV treatment in states without Medicaid expansion. A third of KeY Treat participants were actively injecting drugs and 40% indicated recent drug use, which would negatively impact their ability to easily access treatment in seven US states. More than 85% of KeY Treat participants started treatment the same day as screening. However, same-day test and treat models would not be possible in almost half of US states because of preauthorization requirements that limit the ability of providers to employ innovative point-of-care RNA screening. Conclusions: As an elimination plan takes shape in the United States, it is clear that it will be necessary to remove all restrictions for accessing treatment to allow for meaningful increases in HCV treatment uptake and cure.
Document Type
Article
Publication Date
2026
Digital Object Identifier (DOI)
https://doi.org/10.1111/jrh.70128
Funding Information
National Cancer Institute; National Institute on Drug Abuse; National Institutes of Health
Repository Citation
Havens, Jennifer R.; Williams, Brittney D.; Schaninger, Takako; Shepherd-Tackett, Virginia A.; Lofwall, Michelle R.; Staton, Michele; Walsh, Sharon L.; and Knudsen, Hannah K., "Clinical and demographic characteristics of participants in a hepatitis C treatment trial in rural Kentucky: How policies around treatment access may impact elimination efforts in the United States" (2026). Behavioral Science Faculty Publications. 94.
https://uknowledge.uky.edu/behavsci_facpub/94
Notes/Citation Information
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2026 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.