Inclusion Criteria:

• 1. Current or past history of drug injection;
• 2. Health insurance that will cover HCV medications (study staff will work with those who are eligible but have not signed up for insurance prior to study enrollment)
• 3. Lives in one of the study counties in NH and VT, and plans to remain in the study region for the next 12 months;
• 4. Age 18 years or older;
• 5. Speaks English;
• 6. Capacity to voluntarily provide informed consent;
• 7. Will accept randomized assignment, and participate in follow-up over 12 months;
• 8. Will provide releases to access community medical records;
• 9. Will provide names and contact information of at least 3 persons for re-contact purposes;
• 10. Not previously treated for HCV;
• 11. Not pregnant or trying to conceive;
• 12. HCV antibody positive on point-of-care rapid test.

Exclusion Criteria:

• 1. Unable to obtain venous blood sample for mandatory laboratory testing
• 2. HCV viral load undetectable
• 3. Hepatitis B surface antigen (HBsAg) positive;
• 4. Significant renal failure (eGFR 30 mL/min/1.73m2 or less, or end-stage renal disease requiring dialysis);
• 5. Decompensated cirrhosis, as manifested by liver fibrosis on elastography (FibroScan) and/or Fibrosure blood test plus at least one of the following symptoms:
• i. Observed jaundice (yellowing of the eyes and skin) ii. Self-reported increasing abdominal size (ascites) and leg edema iii. Observed periods of confusion consistent with encephalopathy iv. Self-reported history of gastrointestinal bleeding.