HEP C free PR: integrated rapid HCV care for people with SUD, SMI, and homelessness across 38 high-need municipalities in puerto rico - HEP C free puerto rico integrated care pilot will screen…

The Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) awarded Mennonite General Hospital, Inc. (MGHPR) $11,407,500 on September 30, 2025, under the Substance Abuse and Mental Health Services Projects of Regional and National Significance program (CFDA 93.243) to deliver integrated hepatitis C screening, testing, and rapid treatment across Puerto Rico.

Over three years, the HEP C FREE Puerto Rico Integrated Care Pilot will screen 10,000 high-risk adults for hepatitis C virus (HCV), initiate direct-acting antiviral (DAA) therapy in 1,150 persons, and confirm sustained virologic response at 12 weeks (SVR12) in 900 people. The project embeds opt-out, point-of-care HCV/HIV testing and same-day DAA initiation across MGHPR's 11 emergency departments, 5 certified community behavioral health clinics, a psychiatric unit, and 5 outreach hubs serving 38 medically-underserved municipalities. Same-day treatment uses bedside FIB-4 staging with either an 8-week glecaprevir/pibrentasvir or 12-week sofosbuvir/velpatasvir regimen, supported by pharmacy starter packs and home delivery. Peer specialists, trauma-informed navigators, and a tele-infectious-disease hub provide linkage, adherence support, and motivational interviewing. The project integrates medication for opioid use disorder, psychiatric care, HAV/HBV vaccination, naloxone distribution, and housing navigation for unstably housed clients.

The recipient serves low-income, Spanish-speaking Puerto Rican adults aged 18 and older with elevated HCV risk and co-occurring substance use disorder, opioid use disorder, or serious mental illness, including 1,302 unhoused persons and 28,000 people who inject drugs. Two-thirds are men aged 23–49; approximately 90 percent hold Medicaid coverage.

Period of performance runs through September 29, 2027. Work is performed in Puerto Rico.

HEP C free PR: integrated rapid HCV care for people with SUD, SMI, and homelessness across 38 high-need municipalities in puerto rico - HEP C free puerto rico integrated care pilot will screen 10,000 high-risk adults, start direct-acting antiviral (DAA) therapy in 1,150, and confirm cure (SVR12) in 900 people with hepatitis C virus (HCV) across 38 medically-underserved municipalities in three years. By embedding OPT-out, point-of-care HCV/HIV testing and same-day daas in every mennonite general hospital (MGHPR) emergency department (11), certified community behavioral health clinic (5), psychiatric unit, and five outreach hubs, the project tackles puerto rico's intertwined epidemics of substance-use disorder (SUD), serious mental illness (SMI), homelessness, and HCV. Peer specialists, trauma-informed navigators, and a tele-infectious-disease hub will drive rapid linkage, high adherence, and durable cures. Project name & applicant. HEP C free puerto rico integrated care pilot - mennonite general hospital, INC. (MGHPR), the island's largest non-profit integrated health system. Population to be served. Low-income, spanish-speaking puerto rican adults (≥ 18 YRS) with elevated HCV risk and CO-occurring SUD/OUD and/or SMI, including 1,302 unhoused persons and 28,000 people who inject drugs. Two-thirds are men aged 23-49; medicaid covers ~90 %. Strategies & interventions. • universal, OPT-out rapid HCV/HIV testing with reflex RNA confirmation in 11 EDS, 6 hospitals, 5 ccbhcs, 7 partner mat clinics, and street teams. • same-day treatment protocol: bedside FIB-4 staging and initiation of an 8-week glecaprevir/pibrentasvir or 12-week sofosbuvir/velpatasvir regimen, supported by pharmacy starter packs and home delivery. • peer navigation, prep-C-lite-guided motivational interviewing, modified directly observed therapy for unstably housed clients, and integration of moud, psychiatric care, HAV/HBV vaccination, naloxone distribution, and housing navigation. • project tele-consults, care compass EHR alerts, and predictive analytics from partner estudios técnicos to drive real-time coordination and quality improvement. Goals & measurable objectives (FY 2026-2028). Goal 1 - identify. Screen 10,000 unduplicated adults across all MGHPR emergency departments, ccbhcs, and communities; deliver ≥ 95 % same-day antibody results and reflex RNA confirmation within 24 hours. Goal 2 - treat. Initiate pangenotypic daas within seven days for 1,150 RNA-positive clients; embed peer-led readiness coaching and achieve ≥ 90 % treatment completion. Goal 3 - cure. Confirm sustained virologic response (SVR12) in 900 patients-an ≥ 85 % cure rate that surpasses samhsa tier 3 (> 100 cures / year); retest high-risk clients at 12 months and hold reinfection to ≤ 5 %. Goal 4 - sustain. Train 300 frontline staff through project echo, activate real-time HCV dashboards in every service site, and secure medicaid/340B reimbursement for daas and peer services by year 3 to institutionalize the model post-grant. People to be served. Annually the project will reach 3,250-3,950 individuals across screening, treatment, navigation, and supportive services; over its lifetime IT will serve approximately 11,000 unduplicated residents and achieve 900 cures-meeting samhsa tier 3 (> 100 cures/YR) micro-elimination benchmarks while strengthening puerto rico's public-health infrastructure.