Fokuo J Konadu, Masson Carmen L, Anderson August, Powell Jesse, Bush Dylan, Ricco Margaret, Zevin Barry, Ayala Claudia, Khalili Mandana
Department of Psychiatry University of California San Francisco San Francisco CA.
Department of Medicine Division of Gastroenterology and Hepatology University of California San Francisco San Francisco CA.
Hepatol Commun. 2020 Mar 3;4(5):646-656. doi: 10.1002/hep4.1492. eCollection 2020 May.
Compared with the general population, homeless individuals are at higher risk of hepatitis C infection (HCV) and may face unique barriers in receipt of HCV care. This study sought the perspectives of key stakeholders toward establishing a universal HCV screening, testing, and treatment protocol for individuals accessing homeless shelters. Four focus groups were conducted with homeless shelter staff, practice providers, and social service outreach workers (n = 27) in San Francisco, California, and Minneapolis, Minnesota. Focus groups evaluated key societal, system, and individual-level facilitators and barriers to HCV testing and management. Interviews were transcribed and analyzed thematically. The societal-level barriers identified were lack of insurance, high-out-of-pocket expenses, restriction of access to HCV treatment due to active drug and/or alcohol use, and excessive paperwork required for HCV treatment authorization from payers. System-level barriers included workforce constraints and limited health care infrastructure, HCV stigma, low knowledge of HCV treatment, and existing shelter policies. At the individual level, client barriers included competing priorities, behavioral health concerns, and health attitudes. Facilitators at the system level for HCV care service integration in the shelter setting included high acceptability and buy in, and linkage with social service providers. Despite societal, system, and individual-level barriers identified with respect to the scale-up of HCV services in homeless shelters, there was broad support from key stakeholders for increasing capacity for the provision of HCV services in shelter settings. Recommendations for the scale-up of HCV services in homeless shelter settings are discussed.
与普通人群相比，无家可归者感染丙型肝炎病毒（HCV）的风险更高，并且在接受HCV治疗时可能面临独特的障碍。本研究旨在了解关键利益相关者对于为入住无家可归者收容所的人员建立通用的HCV筛查、检测和治疗方案的看法。在加利福尼亚州旧金山和明尼苏达州明尼阿波利斯，对无家可归者收容所工作人员、执业提供者和社会服务外展工作者（n = 27）进行了四个焦点小组访谈。焦点小组评估了影响HCV检测和管理的关键社会、系统和个人层面的促进因素和障碍。访谈内容被转录并进行了主题分析。确定的社会层面障碍包括缺乏保险、自付费用高、因当前吸毒和/或酗酒而限制获得HCV治疗，以及支付方批准HCV治疗所需的文书工作过多。系统层面的障碍包括劳动力限制和医疗保健基础设施有限、HCV污名化、对HCV治疗的了解不足以及现有的收容所政策。在个人层面，客户障碍包括相互竞争的优先事项、行为健康问题和健康态度。在收容所环境中促进HCV护理服务整合的系统层面促进因素包括高接受度和支持，以及与社会服务提供者的联系。尽管在扩大无家可归者收容所的HCV服务方面确定了社会、系统和个人层面的障碍，但关键利益相关者广泛支持在收容所环境中增加提供HCV服务的能力。文中讨论了在无家可归者收容所环境中扩大HCV服务的建议。
