D450 Task 2 Population Intervention Plan Example

Test and Treat in One Visit: A Hepatitis C Intervention Plan for Young Adults at a Rural Syringe Services Program

Student Name

Leavitt School of Health, Western Governors University

D450: Community Health and Population-Focused Nursing, Task 2

Course Instructor

Month Day, Year

Test and Treat in One Visit: A Hepatitis C Intervention Plan for Young Adults at a Rural Syringe Services Program

Population and Problem

The earlier assessment of Cane Creek, a composite Appalachian county of about 24,600 people, chose young adults who inject drugs as its population of interest. In short, its diagnosis found that hepatitis C is spreading in this group and going untreated because testing happens mostly in the emergency room and the jail, the closest treatment clinic is 70 miles away with no bus to reach it, and shame and poverty keep people from trying. The numbers behind that finding were an acute infection rate well over twice the state's and nearly four of every five reported cases falling between ages 18 and 39. What follows is one intervention aimed at that diagnosis: the evidence for it, its level of prevention, the partners and resources it needs, how it will be delivered, the barriers it will meet and how its success will be judged.

The Intervention

The intervention is a same-visit hepatitis C test-and-treat service at the county health department's syringe services program. On every afternoon the program is open, a public health nurse offers a fingerstick point-of-care RNA test, which shows current infection rather than past exposure and returns a result within about an hour. Anyone with a positive result is offered, before leaving, a telehealth visit with a nurse practitioner at the federally qualified health center, held in a private room at the program with the nurse present to help. Required baseline blood work is drawn at the same visit. The nurse practitioner prescribes a pangenotypic direct-acting antiviral course, and a peer navigator from the recovery community center helps the person collect the medication and stays in contact through the treatment weeks. People who test negative are offered repeat testing every six months while they continue to inject, in line with national guidance that people with ongoing risk be tested periodically, not once (Schillie et al., 2020).

The plan is deliberately one intervention with several linked steps rather than several separate programs. Testing without treatment would find infections the county cannot yet cure locally, and treatment without testing in this setting would miss the people who most need it. Joining them in one visit, at one site the population already uses, is the whole idea.

Evidence for the Intervention

Each part of the intervention rests on published evidence. The strongest concerns bringing treatment to the place people already attend. In a cluster randomized trial in 12 opioid treatment programs across New York State, treatment delivered through telemedicine visits facilitated by program staff was compared with the usual referral to an off-site specialist. In the telemedicine arm, 92.4% of participants started treatment, compared with 40.4% of those referred, and intention-to-treat cure was 90.3% compared with 39.4%; the effect did not differ between rural and urban participants (Talal et al., 2024). Referral elsewhere, which is the current pathway in Cane Creek County, lost most people before treatment began.

The second part is simplified monitoring. A multinational trial of a minimal monitoring approach, in which participants received the full 12-week course at the start, had no scheduled laboratory visits during treatment and were contacted remotely at two points, reported cure in 95% of those who started treatment, with no treatment-related serious adverse events (Solomon et al., 2022). That result matters in a county where each extra visit means a borrowed car or a missed shift.

The third part is same-day linkage. A health department syringe services program in Seattle introduced point-of-care RNA testing and returned results to 97% of those tested, but only about one in ten people with infection had started medication six months later when same-day treatment was not available, and the authors concluded that a streamlined same-day start would likely improve linkage (Glick et al., 2026). This plan builds that lesson in from the beginning, rather than finding out the hard way.

Level of Prevention

The intervention works mainly at the secondary level of prevention: it finds an existing disease early, before symptoms, and treats it to prevent the long-term damage of chronic infection, including cirrhosis and liver cancer. It also has a primary prevention effect for the community. Every person cured can no longer pass the virus to others through shared equipment, so treating people who continue to inject reduces new infections among their networks. For that reason, the plan does not require abstinence from drug use before treatment, and it pairs cure with continued access to sterile supplies and naloxone at the same site, so that people cured are protected from reinfection as well as possible.

Partners and Resources

The plan uses partners the community assessment already identified, each with a defined contribution.

Delivery Plan

Months 1 to 3: The health department obtains the testing device and trains two nurses; the health center and health department sign an agreement covering telehealth visits, prescribing and data sharing; peer navigators complete training on hepatitis C, confidentiality and motivational conversations. Months 4 to 12: the service runs every Tuesday and Friday afternoon. A person arriving at the program is greeted by a peer navigator, offered the test by the nurse and, while waiting for the result, offered naloxone, supplies and a snack. A positive result leads straight into the telehealth visit and the blood draw; a negative result leads to a reminder card for repeat testing. The peer navigator makes contact by phone, text or in person at weeks 1, 4 and 8, and the person returns for a single test after treatment to confirm cure.

Outreach takes the service to where the population already is. On two evenings a month, the nurse and a peer navigator set up at the recovery community center, and the service is announced through the recovery community's own networks, the syringe services program's text list and the handbills on the laundromat and library boards that the windshield survey noted. Messaging uses plain, nonjudgmental language and avoids words that residents associate with shame.

Barriers and Responses

Stigma and fear of being seen: small towns offer little anonymity. Response: the service sits inside a site people already use for other reasons, and nothing on the building or the paperwork refers to hepatitis C.

Lost contact during treatment: phones are often lost, shut off or shared. Response: peer navigators collect two backup contacts at the first visit, and the full course is dispensed at once so treatment does not depend on returning for refills.

Insurance and cost: some people are uninsured or have lapsed Medicaid. Response: the health center's enrollment staff start applications at the first visit, and patient assistance programs cover the gap.

Reinfection: people who continue to inject can be reinfected after cure. Response: cure is paired with continued access to sterile supplies, repeat testing every six months and a welcome to retreat anyone reinfected, without blame.

Staffing: the program is open only two afternoons a week. Response: the added half-time nurse covers both afternoons, and a second trained nurse provides backup.

Evaluation

The primary indicator is the percentage of program participants aged 18 to 39 with a positive RNA test who start treatment within 30 days of the test. Data source: the syringe services program's participant database linked to the health center's prescribing records under the data-sharing agreement. Baseline: 12%, the share of people referred from the health department to outside treatment last year who were recorded as starting within six months. Target: 60% by the end of month 12. Secondary indicators are the number of RNA tests performed each quarter (target: at least 150 in the first year), the percentage of those starting treatment with a confirmed cure test (target: 70%) and the number of repeat tests among people who tested negative. The project team will look at these figures every month, and the county board of health every quarter.

Sharing Results With the Community

Results will be shared in a form the community can use. A one-page summary will go to the board of health and the county commission after month 6 and month 12, and the peer navigators will present the findings at a meeting of the recovery community center, where participants can say what worked and what did not. A short article in the weekly newspaper will describe the service without identifying anyone. If the targets are met, the plan's next step is to extend the same service to the regional opioid treatment program and to the jail, the two other places where the population of interest can be found.

References

Glick, S. N., Kingston, S., Wilson-Weiberg, K., Casey, A., Schwarcz, L., Vivas Jimenez, G., Parsigian, T., Tinsley, J., Golden, M. R., & Balkus, J. E. (2026). Successful implementation of hepatitis C virus point-of-care testing in a syringe services program. Substance Use & Addiction Journal. Advance online publication. https://doi.org/10.1177/29767342261462112

Schillie, S., Wester, C., Osborne, M., Wesolowski, L., & Ryerson, A. B. (2020). CDC recommendations for hepatitis C screening among adults: United States, 2020. MMWR Recommendations and Reports, 69(2), 1-17. https://doi.org/10.15585/mmwr.rr6902a1

Solomon, S. S., Wagner-Cardoso, S., Smeaton, L., Sowah, L. A., Wimbish, C., Robbins, G., Brates, I., Scello, C., Son, A., Avihingsanon, A., Linas, B., Anthony, D., Nunes, E. P., Kliemann, D. A., Supparatpinyo, K., Kityo, C., Tebas, P., Bennet, J. A., Santana-Bagur, J., . . . Sulkowski, M. (2022). A minimal monitoring approach for the treatment of hepatitis C virus infection (ACTG A5360 [MINMON]): A phase 4, open-label, single-arm trial. The Lancet Gastroenterology & Hepatology, 7(4), 307-317. https://doi.org/10.1016/S2468-1253(21)00397-6

Talal, A. H., Markatou, M., Liu, A., Perumalswami, P. V., Dinani, A. M., Tobin, J. N., & Brown, L. S. (2024). Integrated hepatitis C-opioid use disorder care through facilitated telemedicine: A randomized trial. JAMA, 331(16), 1369-1378. https://doi.org/10.1001/jama.2024.2452