ATLANTA — The use of a mobile pharmacy can substantially reduce barriers to healthcare access, including improving hepatitis C testing and treatment and access to pre-exposure prophylaxis (PrEP), in those who use substances and among other marginalized populations, according to research presented at Infectious Disease Week (IDWeek) 2025 Annual Meeting.

“Although we have these really effective medications that have decreased the rate of death for hepatitis C, we still are seeing 12,000 deaths a year for hep C,” Angela Di Paola, PhD, a postdoctoral associate with the InSTRIDE research group and co-director of the Mobile Pharmacy Clinic, told attendees.

An estimated 3.2 million in the US have hepatitis C, including more than half (55.5%) of people who use substances, Di Paola told attendees, and those using substances face multiple barriers to care, including lack of insurance coverage, stigma, and discrimination at the societal level and, at the community level, poor access to public transportation, phones, pharmacy locations, and local services and resources. Further organizational barriers include challenges navigating the medical system, including coordination of personal and clinic schedules. People who use substances also face interpersonal hurdles to care, including medical mistrust, mental health conditions, and lack of adequate social support.

Although Connecticut has lower hepatitis C infection rates and one of the highest cure rates in the US, there always remains room for improvement, Di Paola said. Therefore, she and colleagues evaluated the impact of the first mobile retail pharmacy and clinic in the US, launched in December 2023. The program, called InMOTION, is a mobile hub-and-spoke healthcare delivery system whose hub is a mobile pharmacy clinic unit. The hub includes a mobile health technician, mobile pharmacist, and both in-person and telemedicine clinicians and clinic.

The “spokes,” meanwhile are community health workers who visit locations like soup kitchens, shelters, parks, the streets, and other places where people congregate to connect them to the hub either physically or through phones or iPads.

“If they need medication, they’re able to get that in the pharmacy that’s on board, where our pharmacist is all day long,” Di Paola said. It’s a full-formulary pharmacy similar to any standard brick-and-mortar pharmacy with more than 400 medications, including acute care medications, such as antibiotics and vaccines, and medications for chronic health conditions, such as diabetes, hypertension, and mental health conditions. The pharmacy also carries naloxone, antiretroviral therapy, PrEP, and hepatitis C medications.

The mobile pharmacy has served 1008 patients through September 2025, including 26 patients with an active hepatitis C infection, through 2751 encounters, and it has dispensed 2913 prescriptions. Half the patients were men (50.8%), and 2.9% were transgender. The patients were a median 48 years old, and just over half (56.6%) had health insurance, including all of those with hepatitis C. The population was racially and ethnically diverse, including more than a third Hispanic patients (37.4%); 44.6% White, 23.9% Black, and 7.1% multi-racial individuals; and 27.3% belonging to other or undisclosed races.

A quarter of the overall patient population used opioids or stimulants (25.1%), but that included 69.2% of those with hepatitis C. Less than half of the population overall (47.7%) and less than a third of those with hepatitis C (30.8%) reported having stable housing. Nearly a quarter of the patients overall (23.6%) and half of those with hepatitis C (50%) were unhoused, with the remainder reporting unstable housing or not disclosing their housing status.

The mobile providers follow standard guidelines from the American Association of the Study of Liver Diseases for the treatment algorithm. The first visit involves standard lab tests, including hepatitis A, B, and C; complete blood count; comprehensive metabolic panel; prothrombin time/International normalized ratio; HIV; and a pregnancy test for those with childbearing potential. Then at a second visit 1-2 weeks later, the pharmacy can dispense medications and give vaccinations. Providers use an FIB-4 calculator to determine whether patients with hepatitis C needed imaging or a referral to gastroenterology/hepatology, including arranging and reviewing the ultrasound if needed. Soon, the pharmacy should have a Cepheid machine added so that they can combine those visits into a single 1-day visit.

Patients can opt for in-person or telehealth care, and medication decisions are made with shared decision-making, where providers explain the options and the pros and cons and let the patients decide what they want. From there, the pharmacists order and dispense medications from the mobile pharmacy, and patients are offered hepatitis A and B vaccines depending on their labs.

Among all 1008 patients, 7.7% came with a self-reported known history of hepatitis C, including 17% of them who had been cured by a previous provider, confirmed in their electronic medical records. Rapid testing with 39% of the other patients revealed eight new infections (2% of those tested).

Among the 73 patients offered confirmatory testing, half accepted (53%), and two thirds of those tests (67%) came back with active viral load, including two that spontaneously resolved and one reinfection. Most of those patients (85%) began treatment with direct-acting antivirals. Of the 11 patients who completed treatment, three had sustained virologic response, two did not clear the infection, three were still within the 12-week window at the time of data collection, one died of overdose, and two were incarcerated.

In a separate presentation about the mobile pharmacy and clinic’s services, Sheila Shenoi, MD, MPH, an associate professor of medicine at Yale School of Medicine, New Haven, Connecticut, presented data on HIV testing and PrEP dispensing. Over a third (36.3%) of the clinic’s visitors underwent HIV testing, and all but three tested negative. Only 22 (6%) of those who tested negative were interested in PrEP, and most of them (5.5% of the tested population) initiated PrEP. Shenoi noted that the first dose of lenacapavir as PrEP was given from the clinic just last week. While the clinic can book future appointments, however, it aims to avoid becoming a long-term provider, so linkage with other services is key, she said.

The mobile pharmacy clinic removes barriers by being a “one-stop shop,” Di Paola said, and by “meeting people where they are” because if all their belongings are in a plastic bag, they are not going to leave that bag on the side of the road while they go to a doctor visit. “We really need to focus on access to testing and treatment,” she said. “Treating people in confined settings, whether that’s a jail or in hospitals, [should be done] as a syndemic approach: treat the person, not one condition. Hepatitis C, HIV, STIs [sexually transmitted infections] — they all happen together.” 

Ellen Eaton, MD, a professor of medicine at The University of Alabama in Birmingham who is not involved with the mobile pharmacy clinic, told Medscape Medical News she was impressed with the level of coordination between clinicians, the medical records, and criminal legal and community partners. Di Paola noted a wide range of community partners who worked with the mobile pharmacy clinic, including St. Vincent De Paul Place, Staywell Health Clinic, New Opportunities, Homeless Hospitality Center, Liberation Programs, Connecticut Harm Reduction Alliance, and BG Homeless Outreach.

Alabama is a state without Medicaid expansion, but Eaton said she thinks a mobile pharmacy clinic like this is feasible in states without Medicaid expansion if there are resources from state and local health departments and coordination among public and academic partners.

“But,” she added, “coordination requires staff and funding, and unfortunately non-Medicaid expansion states are often lacking in these resources as well.” 

Alabama has a steady number of patients who are unhoused and/or lack transportation, so many are trying to replicate this type of model there, Eaton said.

“The literature tells us that meeting this population where they are through mobile services will allow us to better engage and care for this population,” Eaton said. “Mobile units have effectively delivered HIV prevention, treatment, harm reduction, substance use, and social services to vulnerable groups.” 

But using this model requires funding and coordination across multiple disciplines and partners, “and, in this funding climate, we have not seen many opportunities that are appropriate for mobile service delivery,” she said. Further, she added, many of the traditional agencies who have previously provided funding mechanisms for approaches like this, such as Substance Abuse and Mental Health Services Administration, Health Resources and Services Administration, and the CDC, are not currently prioritizing this work.

The research included funding from the National Institute of Drug Abuse. Di Paola reported that an upcoming pilot program will involve distribution of injectable buprenorphine that will be provided by Braeburn, Inc. Shenoi reported that her spouse worked for Merck for 10 years and still has stock in his retirement account. Eaton had no disclosures.

Tara Haelle is a science/health journalist based in Dallas.