Rosebud Sioux Tribe Health Administration Hepatitis C Elimination Initiative Pilot - The Rosebud Sioux Tribe (RST) Health Administration will expand testing for hepatitis C and implement a new low-threshold treatment protocol across its 20 rural settlements to counter a sustained doubling in local HCV cases that began in 2021. The program will utilize mobile medical units to reach remote areas of the reservation and trust lands, coordinate with IHS and other health agencies to pilot an integrated approach to cure HCV, and provide a robust HCV treatment pilot for a population with multiple geographic, economic and social barriers to accessing consistent, quality health care. The Rosebud Sioux Tribe (RST) is one of the largest reservations in South Dakota, home to approximately 33,000 residents, and known for its historical resilience, strong community bonds, and its recent innovations in health and community services. The community faces transportation challenges, high rates of poverty, and considers addressing substance use and disease outbreaks a top priority. According to the South Dakota Department of Health, Todd County, the reservation seat, has one of the highest hepatitis C virus (HCV) case detection rates in the state, with cases rising sharply in 2021 and exceeding 600 per 100,000. To address this urgent need, RST Health Administration will expand its capacity to identify and treat HCV across the reservation. With the relatively recent development of a CLIA-waived automated reverse transcription polymerase chain reaction (RT-PCR) assay that confirms the presence or absence of HCV in the field, and our quickly developing mobile outreach model that brings testing and treatment services directly to RST's communities, we plan to implement low-threshold hepatitis C virus treatment. In parallel, we will conduct a robust campaign to provide education, reach social networks, and organize local stakeholders around HCV treatment. Our low-threshold HCV pilot will include robust wraparound services to support patients, treat sexually transmitted infections, treat substance use disorders, treat serious mental illness, and support the overall health and public health of the community. Over the project period, we aim to demonstrably lower HCV incidence and create a healthier community and, by doing so, clearly demonstrate the community's capacity and resolve to improve conditions for future generations. The project will treat at least 200 community members for HCV, reversing the trend toward infections occurring faster than treatment. We will also conduct community outreach, conduct a community initiative to combat stigma, and provide community-based medical treatment and support for related conditions.
