Author information

¹The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

²University at Buffalo, Buffalo, New York, USA.

³Ochsner Health, Baton Rouge, Louisiana, USA.

⁴Central Outreach Wellness Centers, Pittsburgh, Pennsylvania, USA.

⁵The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.

⁶Arizona Liver Health, Chandler, Arizona, USA.

⁷Avenues Recovery, Covington, Louisiana, USA.

⁸University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.

⁹Main Line Health, Wynnewood, Pennsylvania, USA.

¹⁰University of Utah Health, Salt Lake City, Utah, USA.

¹¹University of California San Francisco, Fresno, California, USA.

¹²TruCare Internal Medicine & Infectious Diseases, DuBois, Pennsylvania, USA.

¹³Spirit Health Medical, Memphis, Tennessee, USA.

¹⁴Harmony Healthcare Orlando, Orlando, Florida, USA.

¹⁵University of California San Diego, San Diego, California, USA.

¹⁶Family Health Centers of San Diego, San Diego, California, USA.

¹⁷San Diego State University School of Public Health.

Abstract

All-oral, direct-acting antivirals can cure hepatitis C virus (HCV) in almost all infected individuals; yet, many individuals with chronic HCV are not treated, and the incidence of acute HCV is increasing in some countries, including the United States. Strains on healthcare resources during the COVID-19 pandemic negatively impacted the progress toward the World Health Organization goal to eliminate HCV by 2030, especially among persons who inject drugs (PWID). Here, we present a holistic conceptual framework termed LOTUS (Leveraging Opportunities for Treatment/User Simplicity), designed to integrate the current HCV practice landscape and invigorate HCV treatment programs in the setting of endemic COVID-19: (A) treatment as prevention (especially among PWID), (B) recognition that HCV cure may be achieved with variable adherence with evidence supporting some forgiveness for missed doses, (C) treatment of all persons with active HCV infection (viremic), regardless of acuity, (D) minimal monitoring (MinMon) during treatment, and (E) rapid test and treat (TnT). The objective of this article is to review the current literature supporting each LOTUS petal; identify remaining gaps in knowledge or data; define the remaining barriers facing healthcare providers; and review evidence-based strategies for overcoming key barriers.