Integrated Care for Patients With High Risk Substance Use and Psychiatric Disorder With Chronic Direct Acting Antiviral Treatment

Inclusion Criteria: * Patients with HCV infection who were referred to the VA HCV clinic and who received the usual initial evaluation in the clinic * All patients 18 and 75 years old with confirmed HCV infection * Patients were required to be classified as "high risk candidates for antiviral treatment" on any one of a set of screening measure in order to participate * Screening measures and cutoffs for inclusion were depression: * Beck Depression Inventory: (BDI) \> 10 * Alcohol use: Alcohol Use Disorders Identification Test (AUDIT-C) \> 4 * PTSD: VA Primary Care PTSD Screen = endorsement of three or more items or any single endorsement of item #3 * Drug use: Drug Use Questionnaire = self-reported drug/alcohol use within 6 months prior to screen Exclusion Criteria: * Lacked a confirmed test of HCV RNA * Had HIV/HCV co-infection and received care at San Diego or Palo Alto sites (these patients were treated in a separate clinic) * Had Hepatitis B (HBV) co-infection * Had decompensated liver disease with active or recent encephalopathy, variceal bleeding, or ascites or Child-Pugh class B or C * Had other significant near term life-threatening diseases * Were treatment non-responders with pegylated Interferon plus ribavirin