Dr. Norah Terrault, a nationally recognized liver specialist at the University of Southern California, has made it her mission to improve care for people living with hepatitis C — a serious liver infection that, if left untreated, can lead to cirrhosis, liver failure, or cancer.
In California, over 200,000 people are living with hepatitis C. Many don’t know they have it, and the ongoing opioid crisis continues to drive new infections — especially in rural and suburban areas, where access to liver specialists is limited.
Recognizing this urgent gap, Dr. Terrault launched a project in 2015 to support primary care providers in diagnosing and treating hepatitis C in their own communities. She adapted a model called Project ECHO — a “hub-and-spoke” system where specialists (the hub) train and support local providers (the spokes) through virtual sessions.
In 2017, the program expanded into ECHO-PLUS, offering two learning options for primary care providers:
The initiative targeted 13 rural Northern California counties — including Humboldt, Mendocino, Lassen, and Siskiyou — all with high rates of hepatitis C. To build trust and boost engagement in these areas, Dr. Terrault brought on an experienced RN outreach recruiter, Jennifer Slepin, who played a key role in the program’s success. This nurse worked directly with clinics, built relationships with local healthcare teams, raised awareness about hepatitis C, and actively encouraged providers to join the program. This hands-on, community-based approach was critical for reaching rural providers who may otherwise have been left out.
In total, 94 providers from 60 clinics participated in ECHO-PLUS. Most chose the group education model, while others opted for the one-on-one telementoring. Both formats led to significant improvements in provider knowledge and confidence. Notably, providers who received individual telementoring became ready to treat patients even faster.
Building on this success, Dr. Terrault recently expanded the program to Los Angeles, launching an urban version of ECHO-PLUS. This latest effort includes partnerships with providers serving low-income and unhoused populations, including the University of Southern California’s Street Medicine program.
Dr. Terrault’s work shows that by investing in local providers — and by combining innovative education models with community-based outreach — we can expand access to life-saving hepatitis C treatment across both rural and urban California.
Building capacity and increasing education amongst healthcare workers is a key value of a NOhep Medical Visionary. Both Norah and Jennifer demonstrate the importance of advocacy achieving real-world impact in fighting for the elimination of hepatitis.
