Cherokee nation strategic tribal initiative to treat and cure hepatitis C virus (STITCH) program - using a same-day test and treat model, the cherokee nation strategic tribal initiative to treat and…

The Cherokee Nation received a $2.09 million Project Grant award effective September 30, 2025, through the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Treatment under the Substance Abuse and Mental Health Services Projects of Regional and National Significance program (CFDA 93.243). The Cherokee Nation Strategic Tribal Initiative to Treat and Cure Hepatitis C Virus (STITCH) Program implements a same-day test-and-treat service delivery model to eliminate Hepatitis C Virus (HCV) from the Cherokee Nation reservation across its 14-county service area in northeastern Oklahoma. The program targets high-risk populations, including individuals experiencing housing insecurity, substance use disorders, and mental health illnesses, with the goal of identifying and screening hard-to-reach populations and strengthening engagement in care and treatment initiation among those diagnosed with HCV infections.

The STITCH Program delivers integrated community-based clinical services combining HCV screening, diagnosis, treatment, and prevention activities with secondary services addressing HIV and syphilis diagnosis, treatment, and prevention, as well as identification and management of substance use disorders and mental health conditions among Cherokee Nation citizens and non-citizens. As of April 2025, Cherokee Nation Health Services had screened approximately 87,000 unique patients and identified over 2,000 HCV-positive patients, with approximately 54 percent initiating treatment. The two-year project period extends through September 29, 2027, and represents a strategic federal investment in addressing hepatitis C elimination and related behavioral health disparities among American Indian and Alaska Native populations.

Cherokee nation strategic tribal initiative to treat and cure hepatitis C virus (STITCH) program - using a same-day test and treat model, the cherokee nation strategic tribal initiative to treat and cure HCV (STITCH) program aims to eliminate HCV from the cherokee nation reservation by testing individuals at high-risk of infection, including individuals with housing insecurities, substance use disorders (SUDS), and mental health illnesses. There is an estimated 2.4 million individuals living with chronic HCV in the united states (US). American indian/alaska native (AI/an) individuals have a higher incidence rate of HCV infection and mortality rate compared to other populations. AI/an people, including cherokee people, experience higher prevalence of homelessness, SUD, and mental illness, including severe mental illness (SMI). Between october 2012 and july 2024, cherokee nation health services (CNHS) screened approximately 87,000 unique patients for HCV infection. As of april 2025, over 2,000 patients had tested positive, with approximately 54% initiating treatment. To achieve HCV elimination in cherokee nation, there remains a critical need to identify and screen hard-to-reach populations and to strengthen engagement in care and treatment initiation among those diagnosed with HCV infections within the cherokee nation reservation. Secondary goals are to increase the diagnosis, treatment, and prevention of HIV and syphilis, as well as improving the identification and management of SUD and mental health conditions, among high-risk citizens and non-citizens of tribal nations within the cherokee nation reservation. The reservation covers 14 total counties in northeast oklahoma, including all of six counties and parts of an additional eight counties. This program aims to integrate community-based approaches with clinical services to screen, diagnose, treat, and prevent HCV along with HIV, and syphilis infections in cherokee nation. This program will partner with community coalitions to identify local organizations that serve high-risk populations, including individuals experiencing substance use disorders and housing instability. When individuals engage with these organizations, they will be invited to receive testing for HCV using RNA point-of-care kits and HIV/syphilis using antibody-based point-of-care kits. Individuals who test positive for HCV will be scheduled for a same day visit with a healthcare provider to review results, discuss next steps, and initiate treatment as appropriate. Staff will follow standard protocols to support care continuity, including contacting patients via telephone and mail for follow-up appointments, reminders and rescheduling as needed. All patients will also receive a behavioral health assessment to identify and address any behavioral health needs as indicated. As part of the clinical services approach, CNHS will prioritize increasing provider education and awareness of current HCV screening and treatment guidelines. Further, CNHS will deploy patient navigators to support patients through the HCV/HIV/syphilis and behavioral health cascade of care. Finally, CNHS will use incentive-based strategies - integrated across both community and clinical settings - to enhance patient engagement in screening and HCV treatment. Throughout this process, program activities will be continuously evaluated to guide and refine implementation throughout the project period.