Closing the Gap From HCV Diagnosis to Cure: Norah Terrault, MD, MPH

At IDWeek 2026, held October 21-24 in Washington, DC, Norah Terrault, MD, MPH, a professor of medicine and chief of the Division of Gastrointestinal and Liver Diseases at the Keck School of Medicine of the University of Southern California, spoke with The American Journal of Managed Care^® (AJMC^®) about the gaps between hepatitis C diagnosis and cure in the US and why expanding treatment into primary care is essential to elimination efforts.

This interview has been edited for clarity.

AJMC: Your talk asks what the US should focus on to eliminate hepatitis C. Where do you see the biggest gaps between diagnosis and cure for patients in the US today?

Terrault: Part of my talk is really a bit geared toward specialists since this is an ID meeting. So I’m really trying to engage the specialists in infectious disease in particular. But stepping back in terms of what the US needs, we have gaps in diagnosis; it’s estimated that still one-third of individuals are infected but don’t know it. There’s that gap, but we still have a really remarkable gap between having a diagnosis and being cured, which is surprising since we have such great therapies that are highly effective and really quite straightforward to execute, right?

I would say that’s really our big challenge: once we have that diagnosis, how do we make sure we’re getting people onto treatment in a timely fashion and getting more people to cure? Estimates suggest that of the people who are diagnosed, only a third of those have been treated within a year of their diagnosis. Clearly, we have a lot of work to do in both places, both diagnosis and treatment.

But I think we would want to say that we have a lot of work to do, particularly for those who already know they have hepatitis C, and we could get those individuals cured with a really short course of treatment. I think we really want to put some energy into that.

AJMC: Through ECHO, you’ve trained primary care physicians in California to care for patients with hepatitis. Why is expanding treatment into primary care so important to elimination efforts?

Terrault: There are not enough specialists. That’s the first thing, and also, that’s where diagnosis is usually done, right? I don’t diagnose hepatitis C in my specialty clinic. I get people referred who already have a diagnosis, and because we know there’s a gap between that diagnosis and getting treatment, we’re trying to eliminate that. We want primary care to really have the skills and the knowledge and the confidence to be able to make the diagnosis and do the treatment, and so we need to train them.

And it’s absolutely doable. I have done it through ECHO. Many individuals have been trained. The diagnosis and treatment steps are really quite straightforward, and over time we’ve really worked to make the treatment algorithms very simple so that they can be brought to primary care. So if we want to reach the maximum number of individuals, the right strategy is to do a test-and-treat within primary care and use specialists for the more complicated patients, the ones who have more nuances around their treatment.

But the vast majority will be very easily diagnosed and treated by their primary care, and that increases our reach, right? And ultimately, to get to elimination, we want to have every adult tested and those who are diagnosed treated. We need primary care to partner with us to do that.