Community-Based Unified Response to Eliminate Hepatitis C (CURE) - Project Title: Community-Based Unified Response to Eliminate Hepatitis C (CURE) Applicant Organization: Meharry Medical College Target Population: People who use drugs (PWUD), individuals experiencing homelessness, and those with co-occurring mental illness in Davidson County, TN Strategy: Deliver low-barrier, same-day HCV testing and treatment integrated with behavioral health, HIV, and substance use services Goal: Eliminate HCV among high-risk populations by increasing testing, treatment access, retention, and sustained virologic response (SVR) Abstract: The Community-Based Unified Response to Eliminate Hepatitis C (CURE) initiative, led by Meharry Medical College, seeks to eliminate hepatitis C virus (HCV) among people who use drugs (PWUD), individuals experiencing homelessness, and those living with co-occurring mental illness in Nashville/Davidson County, TN. Despite being a national medical education and health equity leader, Tennessee has among the highest HCV infection rates in the U.S., exacerbated by fragmented care systems, low Medicaid uptake, and limited access to evidence-based treatment for vulnerable populations. The CURE project will implement an integrated, person-centered, and low-barrier model across four service sites: the Meharry Addiction Clinic (MAC), the Elam Mental Health Center, the Meharry Community Wellness Center (MCWC), and the HOPE Mobile Outreach Clinic. Services will include same-day HCV antibody and RNA testing using point-of-care diagnostics; immediate liver staging; and initiation of direct-acting antiviral (DAA) therapy. All services are co-located with HIV testing and care, mental health counseling, medication for opioid and alcohol use disorder (MOUD/MAUD), and peer-led recovery support. Over the 3-year project period, CURE will: Provide rapid HCV screening to at least 750 high-risk individuals (250/year); Initiate DAA treatment for a minimum of 405 participants; Achieve sustained virologic response (SVR12) in ≥85% of those treated; Train 10+ prescribers in HCV care using evidence-based curricula; Provide co-located HCV, SUD, and mental health services to 100% of enrolled clients; Increase HAV/HBV vaccination rates and implement motivational incentives to support adherence and cure. The project leverages a unified 340B pharmacy infrastructure, mobile care delivery, and an implementation science evaluation guided by the RE-AIM framework. Meharry will coordinate with peer-led housing organizations, TennCare navigators, and harm reduction experts to address structural barriers, improve retention, and advance health equity. The proposed activities are fully aligned with the NOFO's required and allowable strategies and will create a replicable model for syndemic care integration in non-Medicaid expansion states.
