Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness
Hepatitis C virus (HCV) prevalence is high among people experiencing homelessness, but barriers to scaling up HCV testing and treatment persist. We aimed to implement onsite HCV testing and education and evaluate the effectiveness of low‐barrier linkage to HCV therapy among individuals accessing hom...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2022-01-01
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| Series: | Hepatology Communications |
| Online Access: | https://doi.org/10.1002/hep4.1791 |
| _version_ | 1797935757931839488 |
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| author | Mandana Khalili Jesse Powell Helen H. Park Dylan Bush Jessica Naugle Margaret Ricco Catherine Magee Grace Braimoh Barry Zevin J. Konadu Fokuo Carmen L. Masson |
| author_facet | Mandana Khalili Jesse Powell Helen H. Park Dylan Bush Jessica Naugle Margaret Ricco Catherine Magee Grace Braimoh Barry Zevin J. Konadu Fokuo Carmen L. Masson |
| author_sort | Mandana Khalili |
| collection | DOAJ |
| description | Hepatitis C virus (HCV) prevalence is high among people experiencing homelessness, but barriers to scaling up HCV testing and treatment persist. We aimed to implement onsite HCV testing and education and evaluate the effectiveness of low‐barrier linkage to HCV therapy among individuals accessing homeless shelters. HCV rapid testing was performed at four large shelters in San Francisco (SF) and Minneapolis (MN). Sociodemographic status, HCV risk, barriers to testing, and interest in therapy were captured. Participants received information about HCV. Those testing positive underwent formal HCV education and onsite therapy. Multivariable modeling assessed predictors of receipt of HCV therapy and sustained virologic response (SVR). A total of 766 clients were tested. Median age was 53.7 years, 68.2% were male participants, 46.3% were Black, 27.5% were White, 13.2% were Hispanic, and 57.7% had high school education or less; 162 (21.1%) were HCV antibody positive, 107 (66.0%) had detectable HCV RNA (82.1% with active drug use, 53.8% history of psychiatric illness), 66 (61.7%) received HCV therapy, and 81.8% achieved SVR. On multivariate analysis, shelter location (MN vs. SF, odds ratio [OR], 0.3; P = 0.01) and having a health care provider (OR, 4.1; P = 0.02) were associated with receipt of therapy. On intention to treat analysis, the only predictor of SVR when adjusted for age, sex, and race was HCV medication adherence (OR, 14.5; P = 0.01). Conclusion: Leveraging existing homeless shelter infrastructure was successful in enhancing HCV testing and treatment uptake. Despite high rates of active substance use, psychiatric illness, and suboptimal adherence, over 80% achieved HCV cure. This highlights the critical importance of integrated models in HCV elimination efforts in people experiencing homelessness that can be applied to other shelter settings. |
| first_indexed | 2024-04-10T18:20:12Z |
| format | Article |
| id | doaj.art-7642eda21f3040158deaefa2509b03ee |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T18:20:12Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-7642eda21f3040158deaefa2509b03ee2023-02-02T07:25:54ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2022-01-0161506410.1002/hep4.1791Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing HomelessnessMandana Khalili0Jesse Powell1Helen H. Park2Dylan Bush3Jessica Naugle4Margaret Ricco5Catherine Magee6Grace Braimoh7Barry Zevin8J. Konadu Fokuo9Carmen L. Masson10Division of Gastroenterology and Hepatology Department of Medicine University of California San Francisco San Francisco CA USAHennepin Healthcare Minneapolis MN USADivision of Gastroenterology and Hepatology Department of Medicine University of California San Francisco San Francisco CA USADivision of Gastroenterology and Hepatology Department of Medicine University of California San Francisco San Francisco CA USASan Francisco Department of Public Health Street Medicine and Shelter Health San Francisco CA USAHennepin Healthcare Minneapolis MN USADivision of Gastroenterology and Hepatology Department of Medicine Zuckerberg San Francisco General Hospital San Francisco CA USAHennepin Healthcare Minneapolis MN USASan Francisco Department of Public Health Street Medicine and Shelter Health San Francisco CA USADepartment of Psychiatry University of California San Francisco San Francisco CA USADepartment of Psychiatry University of California San Francisco San Francisco CA USAHepatitis C virus (HCV) prevalence is high among people experiencing homelessness, but barriers to scaling up HCV testing and treatment persist. We aimed to implement onsite HCV testing and education and evaluate the effectiveness of low‐barrier linkage to HCV therapy among individuals accessing homeless shelters. HCV rapid testing was performed at four large shelters in San Francisco (SF) and Minneapolis (MN). Sociodemographic status, HCV risk, barriers to testing, and interest in therapy were captured. Participants received information about HCV. Those testing positive underwent formal HCV education and onsite therapy. Multivariable modeling assessed predictors of receipt of HCV therapy and sustained virologic response (SVR). A total of 766 clients were tested. Median age was 53.7 years, 68.2% were male participants, 46.3% were Black, 27.5% were White, 13.2% were Hispanic, and 57.7% had high school education or less; 162 (21.1%) were HCV antibody positive, 107 (66.0%) had detectable HCV RNA (82.1% with active drug use, 53.8% history of psychiatric illness), 66 (61.7%) received HCV therapy, and 81.8% achieved SVR. On multivariate analysis, shelter location (MN vs. SF, odds ratio [OR], 0.3; P = 0.01) and having a health care provider (OR, 4.1; P = 0.02) were associated with receipt of therapy. On intention to treat analysis, the only predictor of SVR when adjusted for age, sex, and race was HCV medication adherence (OR, 14.5; P = 0.01). Conclusion: Leveraging existing homeless shelter infrastructure was successful in enhancing HCV testing and treatment uptake. Despite high rates of active substance use, psychiatric illness, and suboptimal adherence, over 80% achieved HCV cure. This highlights the critical importance of integrated models in HCV elimination efforts in people experiencing homelessness that can be applied to other shelter settings.https://doi.org/10.1002/hep4.1791 |
| spellingShingle | Mandana Khalili Jesse Powell Helen H. Park Dylan Bush Jessica Naugle Margaret Ricco Catherine Magee Grace Braimoh Barry Zevin J. Konadu Fokuo Carmen L. Masson Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness Hepatology Communications |
| title | Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness |
| title_full | Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness |
| title_fullStr | Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness |
| title_full_unstemmed | Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness |
| title_short | Shelter‐Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness |
| title_sort | shelter based integrated model is effective in scaling up hepatitis c testing and treatment in persons experiencing homelessness |
| url | https://doi.org/10.1002/hep4.1791 |
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