Since 2002, clinicians have been encouraged to offer chronic hepatitis C virus (HCV) treatment to patients with injection drug use histories. We conducted 69 baseline and 35 follow-up interviews between September 2002 and November 2004 with HCV patients who were treatment-naïve and receiving regular medical care at an HIV or methadone clinic in New York City at baseline. Of the 31 patients reinterviewed, 20 (65%) were offered treatment but only 2 (7%) were treated. Reasons for failure to be reinterviewed were loss to follow-up at the original site of care (30), death (6), and refusal to be reinterviewed (2). Whereas offers of HCV treatment may be increasing, there is a need to improve continuity of care, patient-provider communication, and patient education regarding HCV treatment options for treatment rates to improve.