Expanded screening for hepatitis C virus (HCV) infection aims to improve awareness of diagnosis, yet treatment uptake remains suboptimal due to structural, social, and individual-level barriers. People who use drugs face further challenges in accessing HCV treatment due to fragmented care, stigma, and limited support. Strategies to overcome these challenges are needed to improve health equity and achieve HCV elimination. We developed a quality improvement pilot project to integrate expedited DAA initiation, defined as prescribing of DAA during hospital admission. The pilot program launched at two hospitals in Philadelphia on July 1, 2025, occurring within a health system that provides default HCV antibody screening with reflex to viral load for all hospitalized adults. All DAA-naive, non-pregnant adults are considered eligible if they 1) have Pennsylvania medical insurance, 2) are clinically stable and can make medical decisions, and 3) planning discharge to a residence or facility allowing safe storage of medication. If a patient is deemed an appropriate candidate following EHR review and bedside evaluation by the ID physicians, and patient desires expedited treatment, a DAA prescription is submitted to the onsite outpatient specialty pharmacy and delivered to the inpatient care team for initiation. Housing stability, safe discharge planning and out-of-state insurance remain significant barriers to HCV treatment.