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Background: Direct acting antivirals (DAAs) are over 95% effective at curing hepatitis C virus (HCV) infection, yet treatment rates remain low among people who inject drugs (PWID), a priority population for HCV treatment. Given the high prevalence of HCV among PWID, this study looks to characterize treatment uptake and completion among PWID in a safety-net healthcare system in a large city. Methods: We conducted a retrospective study to identify individuals with evidence of HCV (detectable HCV RNA) between 11/01/2021 to 10/31/2023 and evidence of possible or definite injection drug use (IDU) who accessed care within our integrated healthcare system. We then reviewed medical records of individuals we identified with HCV and IDU to determine demographic characteristics and progression through the HCV care continuum. We compared demographic characteristics at different stages of the care continuum to assess for factors associated with completion of each stage. Results: 1165 individuals had positive HCV RNA results in our medical system during the study period. Of those, 149 individuals had evidence of definite (n=118, 80.3 %) or possible (n=29, 19%) IDU. 34.2% (n=51) of the study population met with a HCV treatment provider, 26.8% (n=40) started treatment, 25.5% (n=38) completed treatment, and 18.1% (n=27) had evidence of SVR12. Proportions of individuals linked to care did not differ significantly by gender, housing status, IDU status (definite vs. possible), or race/ethnicity. Conclusions: Over a two-year period, only 26.8% of the 149 individuals with IDU and HCV started HCV treatment. The largest barrier in achieving cure was linking to a medical visit for HVC care after a positive HCV RNA test. Almost three quarters (74.5%) of those who met with a treatment provider completed treatment. No statistical difference was observed in linkage to care based on gender, race/ethnicity, age or housing status. Of those who did not complete HCV treatment, most were lost to follow up without a documented reason in the electronic medical record.
