Hepatitis C virus testing, liver disease assessment and direct‐acting antiviral treatment uptake and outcomes in a service for people who are homeless in Sydney, Australia: The LiveRLife homelessness study

Abstract

People who are homeless have increased hepatitis C virus (HCV) infection risk, and are less likely to access primary healthcare. We aimed to evaluate HCV RNA prevalence, liver disease burden, linkage to care and treatment uptake and outcomes among people attending a homelessness service in Sydney. Participants were enrolled in an observational cohort study with recruitment at a homelessness service over eight liver health campaign days. Finger-stick whole-blood samples for Xpert® HCV Viral Load and venepuncture blood samples were collected. Participants completed a self-administered survey and received transient elastography and clinical assessment by a general practitioner or nurse. Clinical follow-up was recommended 2-12 weeks after enrolment. For participants initiating direct-acting antiviral (DAA) therapy, medical records were audited retrospectively and treatment outcome data were collected. Among 202 participants (mean age, 48 years), 82% were male (n = 165), 39% (n = 78) reported ever injecting drugs, of whom 63% (n = 49) injected in the previous month. Overall, 23% (n = 47) had detectable HCV RNA and 6% (n=12) had cirrhosis. HCV RNA prevalence among participants with either injecting or incarceration history was 35% (37/105), compared to 4% (3/73) among participants without these risk factors. Among those with detectable HCV RNA, 23 (49%) commenced therapy, of whom 65% (n = 15) achieved sustained virological response, while the remainder had no available treatment outcome. No participant living with viral hepatitis who generously participated in this study.

We know DAAs work, so now what? Simplifying models of care to enhance the hepatitis C cascade

“…Amongst PWID and other vulnerable populations, rapid testing has been shown to substantially increase coverage and referral rates . To date, many services have not been developed for vulnerable populations such as the homeless, PWID and prisoners, which must both contend with numerous social determinants that contribute to poor quality of life and poor social functioning as well as health inequalities . It should be emphasized that HCV treatment should be offered based on clinical rather than social factors or injecting‐related behaviours , underlining the necessity of overcoming obstacles to HCV treatment delivery to PWID.…”

Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: A community consultation in Iran

“…Homelessness was another signi cant competing priority among PWID. Previous work has shown that homeless people often face numerous complex issues including but not limited to domestic violence, mental illness, and addiction disorders (47)(48)(49) and are less likely to be linked to general practitioners or to receive healthcare than the general population (50,51). This is while the national evidence suggests that homeless people are at increased risk of HIV and HCV infections (52)(53)(54)).…”

Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs; A community consultation in Iran

“…Homelessness was found to be another significant competing priority among PWID. Previous work has shown that homeless people often face numerous complex issues including but not limited to domestic violence, mental illness, and addiction disorders (47)(48)(49) and are less likely to be linked to general practitioners or to receive healthcare than the general population (50,51). This is while the national evidence suggests that homeless people are at increased risk of HIV and HCV infections (52)(53)(54).…”