Patient‐reported experiences with direct acting antiviral therapy in an integrated model of hepatitis C care in homeless shelters

Kim, Stephanie; Powell, Jesse; Naugle, Jessica; Ricco, Margaret; Magee, Catherine; Masson, Carmen L.; Zevin, Barry; Bush, Dylan; Khalili, Mandana

doi:10.1111/jvh.13544

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…Social risk and need have previously been demonstrated to be associated with increased HCV vulnerability 39 . Further, notable HCV exposure and barrier to care issues have also been well documented amongst both homeless and incarcerated populations in the US 40,41 . In this study, when considering social risk factors, we again see Millennials, in particular, disproportionately affected, specifically by incarceration, lack of health insurance, mental health disorder comorbidity and substance misuse (current and previous).…”

Section: Discussionmentioning

confidence: 59%

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Birth cohort‐specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age‐related characteristics and outcomes

Walter,

Prados,

Lloyd

et al. 2024

Journal of Viral Hepatitis

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The emergency department (ED) has increasingly become an important public health partner in non‐targeted hepatitis C virus (HCV) testing and referral to care efforts. HCV has traditionally been an infection associated with the Baby Boomer generation; however, recent exacerbation of the opioid epidemic has resulted in a growing number of younger cohorts, namely Millennials, also impacted by HCV. Examination of this age‐related demographic shift, including subsequent linkage success and linkage barriers, from the perspective of an ED‐based testing and linkage programme may have implications for future population and health systems interventions. A retrospective descriptive chart review was performed, inclusive of data from August 2015 through December 2020. We compared the quantity of positive HCV screening antibody (Ab) and confirmatory (RNA) tests and further considered linkage rates and correlative demographics (e.g. gender, race). Patient barriers to HCV care linkage (e.g. substance misuse, lack of health insurance, homelessness) were also evaluated. The data set was disaggregated by birth cohort to include Silent Generation (SG) (1928–45), Baby Boomer (BB) (1946–64), Generation X (Gen X) (1965–80), Millennial (1981–96) and Generation Z (1997–2012). Descriptive statistics and chi‐square analysis were performed. Overall, 83,817 patients were tested for HCV (50.6% of eligible); 6187 (7.4%) were HCV Ab positive, and 2665 were HCV RNA positive (3.2%). RNA‐positive individuals were more likely to be white (70.4%) and male (67.7%); generational distribution was similar (BB 33.3%, Gen X 32.0% and Millennials 32.7%). Amongst Ab‐positive patients, white (45.5%), male (47.2%) and Millennial (49.7%) individuals were most likely to be RNA‐positive. Overall, 28.1% of the RNA‐positive cohort successfully linked to care; linkage to care rates were significantly higher in older generations (38.1% in BB vs. 17.8% in Millennials) (p < .00001). Over 90% were identified as having at least one linkage to care barrier. Younger generations (Gen X and Millennials) were disproportionately impacted by linkage barriers, including incarceration, lack of health insurance, history of mental health and substance use disorders, as well as history of or active injection drug use (IDU) (p < .00001). Older generations (SG and BB) were more likely to be impacted by competing medical comorbidities (p < .00001). The ED population represents a particularly vulnerable, at‐risk cohort with a high prevalence of HCV and linkage to care barriers. While past HCV‐specific recommendations and interventions have focused on Baby Boomers, this data suggests that younger generations, including Gen X and Millennials, are increasingly affected by HCV and face disparate social risk and social need factors which impede definitive care linkage and treatment.

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Section: Discussionmentioning

confidence: 59%

“…39 Further, notable HCV exposure and barrier to care issues have also been well documented amongst both homeless and incarcerated populations in the US. 40,41…”

Section: Discussionmentioning

confidence: 99%

Birth cohort‐specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age‐related characteristics and outcomes

Walter,

Prados,

Lloyd

et al. 2024

Journal of Viral Hepatitis

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A novel multisite model to facilitate hepatitis C virus elimination in people experiencing homelessness

Mourad,

McGeer,

Gray

et al. 2024

JHEP Reports

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Adherence to Hepatitis C Therapy in a Shelter-Based Education and Treatment Model Among Persons Experiencing Homelessness

Powell

Ricco

Naugle

et al. 2021

Open Forum Infectious Diseases

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Background Medication adherence is a common reason for treatment deferment in persons experiencing homelessness. We evaluated adherence to HCV therapy following HCV education in a shelter-based care model. Methods Prospective study conducted at 4 homeless shelters in Minneapolis, MN and San Francisco, CA from 11/2018–1/2021. Sixty-three patients underwent HCV education and treatment. Multivariable modeling evaluated factors associated with (1) medication and (2) overall (composite score of medication, laboratory, and clinic visit) adherence. Results Median age was 56, 73% male, 43% Black, 52% had psychiatric illness, and 81% used illicit drugs and 60% used alcohol in the past year. Following education, 52% were extremely confident in their ability to be adherent to HCV therapy. Medication adherence by patient and provider report was 88% and 48% respectively and 81% achieved HCV cure. Active alcohol use was associated with less confidence in medication adherence (43% vs. 78%, P=0.04). Older age was positively (Coef=0.3) associated with overall adherence to HCV treatment while prior therapy was associated with both medication (OR=0.08) and overall treatment (Coef=-0.87) non-adherence. Conclusions Despite imperfect adherence, SVR rates were still high. Expanding opportunities to treat persons experiencing homelessness in a structured and supportive setting is critical to HCV elimination efforts.

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Patient‐reported experiences with direct acting antiviral therapy in an integrated model of hepatitis C care in homeless shelters

Cited by 3 publications

References 7 publications

Birth cohort‐specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age‐related characteristics and outcomes

Birth cohort‐specific consideration in an Emergency Department Hepatitis C Testing Programme: A description of age‐related characteristics and outcomes

A novel multisite model to facilitate hepatitis C virus elimination in people experiencing homelessness

Adherence to Hepatitis C Therapy in a Shelter-Based Education and Treatment Model Among Persons Experiencing Homelessness

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