A Framework for Emergency Department-Integrated Hepatitis C Test-and-Treat in the United States.

Despite the availability of curative, direct-acting antiviral therapy, hepatitis C virus elimination remains incomplete. Losses across the care cascade continue to limit impact, from initial diagnosis to sustained virologic response. Fewer than 1/3 of individuals ultimately achieve cure. These gaps reflect a delivery system that does not align with the population most affected, many of whom have inconsistent engagement with outpatient care. The emergency department is critical, but underused point of contact, where the burden of undiagnosed and untreated infection is high. This manuscript presents a practical framework for integrating HCV testing and treatment into emergency care within a new United States. It focuses on five domains. Point of care RNA testing allows confirmation of infection during the encounter, reducing delays that contribute to loss to follow up. Treatment initiation is simplified through standardised eligibility criteria and use of pan genomic regimens supported by electronic decision support. A focused safety screen addresses key exclusions, including hepatitis B coinfection, advanced liver disease, renal impairment, and relevant drug interactions. Policy and financial barriers are examined, including prior authorisation requirements, variation of Medicaid coverage, and access to discount pricing programmes. Post treatment follow up is restructured through decentralised approaches such as dried blood spot testing, telemedicine, and linkage to harm reduction services. Implementation will vary across institutions and regions. Regulatory requirements, payer policies, and staffing models remain important constraints. These challenges identify areas for targeted policy reform and prospective study. The emergency department is not traditionally designed for chronic disease management. However, for a curable infection concentrated among patients who rely on episodic care, it may represent the most effective point of intervention.