Background: Hepatitis C virus (HCV) infection is a primary health concern among people who use drugs (PWUDs). Homeless PWUDs that constitute a key population for HCV transmission remain underrepresented in many surveys. Objectives: We performed a proactive street outreach to evaluate HCV infection prevalence among homeless PWUDs in Tel Aviv, identify risk factors associated with HCV infection, awareness of disease status and linkage to care rate. Results: Thirty-eight percent of approached PWUD were willing to participate in the study. Out of 53 subjects who got tested for anti HCV by rapid test, 29 (54.72%) had a positive result, 20 of 29 anti-HCV positive (69%) patients had positive HCV PCR. Risk factors were investigated using structured questionnaires. Heroin use was reported significantly more frequently in the HCV-positive group ( P =  .05, CI 95%), whereas other established risk factors did not reach significance in our cohort. While 21 of 29 (72%) HCV-positive participants were aware of their condition, only 4 of 21 (19%) received treatment in the past, and 2 of 4 (50%) failed to achieve treatment goals, as assessed by HCV PCR. Conclusions: Our data indicate a high prevalence of HCV infection among homeless PWUDs. Importantly, despite relatively high awareness of HCV status in this population, we found strikingly low access to care. These findings motivate novel interventional approaches targeted at improving patient access, and compliance among homeless PWUDs, in an effort to reduce HCV transmission.

Summary Whereas some studies have addressed the conditions and practices required to infuse critical notions into the organizational context of public social services, there is a paucity of knowledge on what a critical public service can look like in actual practice. This article explores the possibility of applying critical theory and practice at the organizational level of public social services. It focuses on one social services department in Israel that underwent a six-year process of learning and implementing the Poverty-Aware Paradigm. Findings Based on an in-depth case study that combines ethnographic and participatory methods, we outline how critical ideas are translated to four organizational principles: developing a critical learning culture, acknowledging services users’ knowledge and skills, leading a critical discourse in the community, and poverty-proofing services and allocating resources to tackle poverty. Each of these principles is presented with derivative organizational practices and a detailed account of their implementation. Applications By broadening the framing of critical practice as an individual, street-level endeavor, the findings offer policymakers and public social services professionals an organizational model that mitigates the negative consequences of current neoliberal and managerial policies around the world.