Fuelled by the opioid crisis, the incidence of hepatitis C virus (HCV) infection in people who use drugs is rising. 1 In national surveillance data, the highest incidence of acute HCV infection is in individuals aged 20-29. 2 This incidence is driven by initiation of injection drug use in this age group: 20% of individuals become HCV-infected within two years of starting to inject drugs, and half within five years. 3 People who use drugs but do not report a history of injection are also at higher risk for hepatitis C than the general population, possibly due to sexual risk or because of unreported injection drug use. 4,5 Several jurisdictions, including New York City, have seen a new peak of HCV prevalence in this younger age group. 6,7 If HCV elimination efforts are to be effective, engaging and treating