Engaging the Community in Designing a Hepatitis C Virus Treatment Program for Adults Experiencing Homelessness

Abstract

Despite the availability of cure for hepatitis C virus (HCV), people experiencing homelessness (PEH) are challenged with initiating and completing HCV treatment. The design of culturally sensitive HCV treatment programs is lacking. The objective was to employ community-based participatory research methods to understand perceptions of HCV-positive PEH, and providers, on the design and delivery of a culturally sensitive, nurse-led community health worker (RN/CHW) HCV initiation and completion program. Four focus group sessions were conducted with HCV-positive PEH ( n = 30) as well as homeless service providers (HSP; n = 7) in Skid Row, Los Angeles. An iterative, thematic approach provided the themes of essentials of successful participant engagement and retention: Role of nurse-Led CHW in promoting: (a) tangible and emotional support; (b) cognitive and behavioral support; and (c) financial and structural resources. The goal of this study is to provide the groundwork for future research of HCV program design to support HCV cure among homeless populations.

Exploratory assessment: Nurse‐led community health worker delivered HCV intervention for people experiencing homelessness

“…Moreover, once screened, initiation into HCV treatment has been low; ranging from 10% to 15% of PEH (Benitez et al., 2020; Coyle et al., 2019; Hawks et al., 2016). Barriers to HCV care have included factors such as lack of awareness of being HCV infected (Norton et al., 2014; Skeer et al., 2018), challenges in accessing health care (Fokuo et al., 2020; Nyamathi, Wall, et al., 2021), ongoing drug and alcohol use (Crowley et al., 2017), and limited HCV treatment availability (Norton et al., 2014). Further, SVR12 has ranged from 81% (Khalili et al., 2022) to 87.5% (Benitez et al., 2020).…”

“…The Comprehensive Health Seeking and Coping Model (Nyamathi, 1989) served as the theoretical framework for this pilot study. It has been well utilized by the research team for decades, focused on promoting the health of PEH with chronic health conditions (Nyamathi, Salem, et al., 2021; Nyamathi et al., 2007; Nyamathi, Wall, et al., 2021; Nyamathi et al., 2006). Based on the CHSCP, several factors should be considered in the implementation of an intervention that will positively impact health outcomes (in this case, HCV treatment completion).…”

“…Behavioral Responses, such as drug and alcohol use are critical to address to promote HCV treatment completion and reduce risk for cirrhosis (Osna et al., 2017; Pateria et al., 2013). In addition, adherence is known to be impacted by a positive relationship between individuals and their healthcare providers (Masson et al., 2020; Nyamathi, Wall, et al., 2021).…”

Perceptions of Homeless Adults and Their Providers on Coping With the Impact of COVID-19 Pandemic on Mental Health, Substance Use, and Harm Reduction Services

“…The theoretical framework that guided this study was the Comprehensive Heath Seeking and Coping Paradigm (Nyamathi, 1989), which originated from the Lazarus & Folkman Stress and Coping Paradigm (Lazarus & Folkman, 1984) and the Schlotfeldt (1981) Health Seeking and Coping Paradigm. As utilized in numerous studies with PEH experiencing significant health disparities (Nyamathi, Salem, et al, 2017; Nyamathi, Shin, et al, 2017; Nyamathi et al, 2021), a number of factors are thought to influence health behaviors.…”

Attitudes Toward Peer-Delivered Sexual-Health Services Among New York City Sexual and Gender Minority Individuals Who Have Sex with Men and Attend Collective Sex Venues

“…Other strengths of peer interventionists are how they can connect with people whom non-peers might have difficulty reaching, work in places that may not be accessible to professional personnel, and intervene at times when services are most needed (Bell et al, 2021; Marshall et al, 2015; Nyamathi et al, 2021; Simoni, Franks, et al, 2011). For instance, several interventions have enlisted peers to provide sexual-health education in gay male community settings (bars or gyms), which have been well-received by participants and venue managers (Elford et al, 2001; Flowers et al, 2002; Kelly et al, 1997; Miller et al, 1998).…”