How to C Change in the Hepatitis C Landscape in Philly

January 28, 2020

C Change, a partnership between the Hepatitis C Allies of Philadelphia (HepCAP) and the Philadelphia Department of Public Health (PDPH), is a project to eliminate Hepatitis C Virus (HCV) among people who use drugs in Philadelphia. Guided by the belief that everyone deserves a cure, C Change is working to transform HCV care delivery by building flexible, low threshold models of integrated care. C Change provides direct patient services, clinical training, and infrastructure support to build treatment capacity in settings not traditionally treating HCV. Currently, C Change works in collaboration with Prevention Point Philadelphia, the city’s syringe service program (SSP), the Steven Klein Wellness Center, a Federally Qualified Health Center (FQHC), and Merakey Parkside, an outpatient medication assisted treatment program.  We sat down with Hannah Zellman, C Change’s Program Manager, to talk about this project and learn more about the work happening across Philadelphia to eliminate HCV among people who use drugs.

Q. Can you tell us about C Change and some of the project’s major accomplishments to date?

We believe that Philadelphia can be the first city to eliminate hepatitis C, and our goal is to support, expand and build the infrastructure needed to make that a reality. The core mission that drives the work is to make treatment and cure accessible and achievable. We’ve been lucky to learn from and with our participants and partnering agencies, and to have the flexibility to respond to challenges and opportunities as they emerge. Right now our focus is on expanding treatment capacity at three sites – Prevention Point Philadelphia, the Steven Klein Wellness Center, and Merakey. Our work with these sites includes clinical training, collaborative workflow development, ongoing clinical consultation and workflow/integration assessment, technical assistance, and support in creating a replicable, reimbursable model of HCV care delivery in substance use disorder settings

Q. What does micro elimination mean and how does it fit into larger efforts to eliminate HCV around the world?

C Change is a micro elimination project because it has a specific focus – eliminating HCV among people who use drugs, and folks who use injection drugs in particular. As with any change strategy, the work has to be achievable, so developing specific, intensive micro elimination programs is an important part of elimination work as a whole. Our focus on people who use drugs is purposeful – up to 60% of new HCV diagnoses are attributed to injection drug use, and 1 in 3 folks who use injection drugs will acquire HCV infection within their first year of using. When folks achieve cure they have better long term health outcomes, and they also can’t transmit HCV to anyone else. But, elimination can only be successful with really substantial scale up of screening, treatment, and harm reduction services that can prevent new HCV infections. The scale of the HCV epidemic in Philly can seem daunting, but we’re in a call to action moment, and have an urgent need to mobilize towards health justice. Philly’s home to a lot of incredibly powerful activists, and when we fight we win. So we have to fight!

Q. Can you tell us about the Care Coordinators that are part of C change and how has this position played a role in the project?

The Care Coordinators – Jessica Santiago, Wilfredo Laboy, Janielle Bryan and Kayla Gray – are the engine that keeps C Change going!  They are embedded full time at our sites, and provide direct patient services and substantially support the creation of infrastructure that will ensure that these programs are sustainable and replicable. They are involved at every phase of the work and in every milestone in a patient’s cure journey: they are fierce advocates, treatment educators, harm reduction counselors, insurance navigators, patient tracking system experts, database wizards, and all around superheroes. At the end of the day, the success of C Change rests in their hands – they are right alongside our participants to troubleshoot barriers and celebrate successes, and they are determined to bring those perspectives to the forefront as we continue to build and learn.

Q. How do you incorporate the patient voice into your work? Can you share a patient success story from C Change?

There are so many victories, but a common thread that emerges is folks’ ability to remain resilient in the face of really serious and distressing circumstances. We’ve seen patients who are unexpectedly incarcerated advocating for themselves to avoid treatment interruption. The Care Coordinators have pulled strings to make sure a patient has a safe place to sleep after they expressed needing shelter in order to be successful with treatment. We had a patient who went toe to toe with a medical provider who tried to tell her that she needed to be sober to get HCV treatment (she changed providers, and has been a vocal advocate in making sure that others know that you CAN get treated even if you are using!)

Q. What are some lessons learned from C Change and what should other partners in Philly know about expanding HCV services for people who use drugs?

We’ve learned a lot since launching C Change in late 2017, including a lot about HCV services that don’t work very well for people. The Care Coordinators are unwavering in lifting those voices up, and lifting them up loudly. One of our most important lessons learned is that patient navigation models – “navigating” patients to care off site – often don’t work. Rather than asking “what is wrong with the patient that they aren’t making it to the appointment?” we asked “what is wrong with the systems of care delivery that patients can’t get to an appointment?”  The solution was to embed care in the places that folks already went to, to expedite access to providers, and think creatively about shrinking or eliminating extra steps in the process to treatment initiation. We have dozens of folks who weren’t able to access HCV care in the navigation model who are now on treatment under the embedded care model.

Q. How can HepCAP coalition partners get involved with C Change?

Achieving HCV elimination requires multiple, concurrent strategies that intervene at the policy, systems and infrastructure level while also providing direct services to support people in their cure journey. HepCAP has an incredible legacy as an advocacy powerhouse responsible for spearheading the removal of Pennsylvania’s hepatitis C treatment restrictions. That win was monumental, but we still have work to do to remove other systemic barriers, including payer silos and the onerous prior authorization process. I believe that HepCAP can drive that work, and can raise the profile of Philadelphia’s advocacy strategy and cutting edge models of care, including embedded, expedited treatment in “non-traditional” settings such as Merakey and Prevention Point.

Q. What is in store for C Change in 2020 and beyond?

We’re going to keep on building! We’re working to document the implementation science and best practices as they emerge so that the programs being built at Merakey, Prevention Point and the Steven Klein Wellness center can serve as models – locally, regionally, and even nationally – for innovative care delivery. This year is also breathing new life into HCV advocacy in Philadelphia, and we’re excited to be a part of that groundswell. Onward towards elimination!

C Change is a project of the Health Federation of Philadelphia. If you’re interested in learning more about C Change, please contact Hannah Zellman at