Shelter-Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness.
Shelter-Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness.
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DOI：
10.1002/hep4.1791
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发表时间：
2022-01
影响因子：
5.1
通讯作者：
Masson CL
中科院分区：
文献类型：
--
作者：
Khalili M;Powell J;Park HH;Bush D;Naugle J;Ricco M;Magee C;Braimoh G;Zevin B;Fokuo JK;Masson CL
丙型肝炎病毒（HCV）在无家可归者中的流行率很高，但扩大HCV检测和治疗的障碍仍然存在。我们的目的是实施现场HCV检测和教育，并评估在无家可归者收容所的个人中低障碍联系HCV治疗的有效性。HCV快速检测在弗朗西斯科（SF）和明尼阿波利斯（MN）的四个大型收容所进行。收集了社会人口学状况、HCV风险、检测障碍和治疗兴趣。参与者获得了有关HCV的信息。那些检测阳性的人接受了正式的HCV教育和现场治疗。多变量模型评估了接受HCV治疗和持续病毒学应答（SVR）的预测因素。共有766名客户接受了测试。中位年龄为53.7岁，68.2%为男性参与者，46.3%为黑人，27.5%为白色，13.2%为西班牙裔，57.7%为高中或以下学历; 162 HCV抗体阳性率为21.1%，66.0%（82.1%）有药物滥用史，53.8%有精神病史，66例（61.7%）接受过HCV治疗，81.8%达到SVR。在多变量分析中，收容所位置（MN vs. SF，比值比[OR]，0.3; P = 0.01）和有医疗保健提供者（OR，4.1; P = 0.02）与接受治疗相关。在意向治疗分析中，调整年龄、性别和种族后，SVR的唯一预测因素是HCV药物治疗依从性（OR，14.5; P = 0.01）。结论：利用现有的无家可归者收容所基础设施，成功地提高了HCV检测和治疗的吸收。尽管活性物质使用率高，精神疾病，和次优的依从性，超过80%的HCV治愈。这突出了在经历无家可归的人中消除HCV的综合模式的至关重要性，这些模式可以应用于其他庇护所环境。
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.
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