Hepatitis C (HCV) is a leading cause of chronic liver disease and mortality worldwide. The World Health Assembly and World Health Organization (WHO) have recognized the need to prevent and control HCV infection, and the WHO proposed that HCV elimination was feasible by 2030 through reducing new chronic infections by 90% and HCV-related mortality by 65%. In the USA, as many as 3 million people are chronically infected with HCV, with more than 30,000 new infections occurring annually. Elimination strategies are urgently needed that focus on the estimated 1.3 million people who inject drugs in the USA, the group at highest risk for acquiring and transmitting HCV infection. The development of oral direct-acting antiviral therapies help to make HCV elimination achievable, with reported cure rates >90%, which can prevent liver disease progression and HCV transmission. However, barriers to the use of direct-acting antiviral therapies for HCV in people who inject drugs persists, including cost of DAAs, poor linkage to care and adherence, possible reinfection and PWID lifestyle. A better understanding of the factors that would promote HCV elimination in people who inject drugs is imperative to inform policy development and strategic planning (eg, efforts to shorten the duration of direct-acting antiviral therapy to lower its cost and increase adherence.