Integrated care model improves hepatitis C treatment access for people with substance use disorder

Andrea Weber, MD, has seen firsthand how separating addiction treatment from other medical care can create obstacles for patients. A new study co-authored by the physician, who holds dual appointments in Internal Medicine and Psychiatry, found that bringing hepatitis C treatment directly into an addiction medicine clinic significantly increased the number of patients who started therapy.  

Published in the American Journal on Addictions, the study examined the impact of an integrated hepatitis C treatment program embedded within the University of Iowa’s addiction medicine clinic. First author Arya Zandvakili, MD, PhD, led the research while completing infectious disease fellowship training and an additional year as a research fellow at UI Health Care. Zandvakili, who is also an alum of our residency program, now works as a physician– scientist at the University of Cincinnati. 

Although highly effective direct-acting antiviral medications can cure hepatitis C infection, many patients with substance use disorder never reach treatment because of the barriers to accessing appropriate care.  

“People with substance use disorders are disproportionately affected by hepatitis C, yet treatment has traditionally been delivered in separate clinical settings,” Weber said. “Patients often need referrals to specialists, additional appointments, transportation, and help navigating multiple health care systems. Each additional step creates another opportunity to fall out of care.”  

Those barriers inspired the team’s efforts to rethink how hepatitis C care is delivered. Instead of requiring patients to establish care with another clinic, the integrated program brought hepatitis C screening and treatment into the addiction medicine clinic where patients were already receiving care.  

Close collaboration between addiction medicine clinicians, infectious disease specialists, pharmacists, nurses, and case managers made the integrated model possible. Telemedicine support also improved access while reducing burden on patients.  

Researchers then compared outcomes before and after the integrated program was established and found a substantial increase in treatment initiation.  

“The most important finding was that integrating hepatitis C care significantly increased treatment initiation,” Weber said. “We also found that patients who received prescriptions directly through the addiction medicine clinic initiated and completed treatment at substantially higher rates than those referred elsewhere. Providing care in a familiar, trusted setting can make a meaningful difference in whether patients engage with treatment.” 

The findings also point to a bigger issue. Health care is often so fragmented that patients must coordinate appointments across different locations and stay in touch with several care teams. For someone facing unstable housing, financial hardship, or the stigma tied to substance use, that alone can be the reason treatment plans fail. Weber said that these logistical barriers can be reduced when providers use integrated care to address co-occurring conditions. She adds, “Our findings reinforce that for many patients, the biggest challenge is not whether treatment works—it’s whether they can access it.” 

For Weber, the study also reflects the strengths of interdisciplinary care, a principle that has shaped both her clinical work and training in Internal Medicine and Psychiatry. 

“This project was only possible because clinicians from multiple disciplines brought their expertise together to create a practical model that expanded access to care,” she said. “Meaningful improvements in patient outcomes often happen when specialties work together and meet patients where they are.”