Integrated Model for Hepatitis C Screening and Linkage to Care in Homeless Population

BACKGROUND: Hepatitis C is a major cause of morbidity and mortality as up to 46% of people infected with Hepatitis C develop cirrhosis and up to 20% develop hepatocellular carcinoma. Over the past year, a new initiative through the DFW Hep B Free organization at the University of Texas Southwestern (UTSW) was formed to target Hepatitis C among the homeless population, starting with screening at the Union Gospel Mission's Calvert Place homeless shelter. This underserved population is vulnerable because of inadequate healthcare access and resources, in addition to other risk factors such as former incarceration and injection drug usage. The main barriers to care for a transient, homeless population are 1) their lack of access to regular healthcare and screenings, 2) their inability to receive screening results via phone or mail, and 3) the difficulty of linking patients to affordable, accessible healthcare and treatment. METHODS: Our model integrates a student-run screening program, an on-site clinic at the shelter, and specialized hepatology services at Parkland Health Hospital System (PHHS), a local safety-net provider, to maximize the strengths that each component offers. Using OraQuick Rapid Hepatitis C Virus (HCV) tests, which screen for HCV antibodies and produce results in 20 minutes, we can deliver test results and provide counseling on the screening day. Under an IRB through a faculty hepatologist, patients that test positive are registered into Parkland Hospital's hepatitis surveillance program. The program then provides patient navigation, financial support, and treatment. RESULTS: On average, the HCV antibody positive rate from screenings at Calvert Place is 12.7% (N=126). 100% of positive patients were contacted with their result. For patients who tested positive (n=16), 2 (12.5%) did not need care (resolved HCV). From the 14 of 16 that had active HCV infections, 50% were lost to follow up and 50% were linked to care at Parkland hepatology clinic. CONCLUSION: Through our integrated model, we have created the foundations for a sustainable system to break down barriers to care while ultimately connecting HCV-positive homeless patients to treatment.