Department of Psychiatry, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA, 94110, USA.
Department of Medicine, University of California San Francisco, Zuckerberg San Francisco General, Hospital and Trauma Center, 1001 Potrero Avenue, NH-3D, San Francisco, CA, 94110, USA.
BMC Infect Dis. 2020 May 29;20(1):386. doi: 10.1186/s12879-020-05103-6.
Hepatitis C virus (HCV) is highly prevalent among homeless persons, yet barriers continue to impede HCV testing and treatment in this population. We studied the experiences of homeless individuals related to accessing HCV care to inform the design of a shelter-based HCV prevention and treatment program.
Homeless shelter clients (10 women and 10 men) of a large shelter in San Francisco participated in gender segregated focus groups. Focus groups followed a semi-structured interview format, which assessed individual, program/system, and societal-level barriers and facilitators to universal HCV testing and linkage to HCV care. Focus group interviews were transcribed, coded, and analyzed using thematic analysis.
We identified key barriers to HCV testing and treatment at the individual level (limited knowledge and misconceptions about HCV infection, mistrust of health care providers, co-morbid conditions of substance use, psychiatric and chronic medical conditions), system level (limited advocacy for HCV services by shelter staff), and social level (stigma of homelessness). Individual, system, and social facilitators to HCV care described by participants included internal motivation, financial incentives, prior experiences with rapid HCV testing, and availability of affordable direct acting antiviral (DAA) treatment, respectively.
Interrelated individual- and social-level factors were the predominant barriers affecting homeless persons' decisions to engage in HCV prevention and treatment. Integrated models of care for homeless persons at risk for or living with HCV address many of these factors, and should include interventions to improve patient knowledge of HCV and the availability of effective treatments.
丙型肝炎病毒 (HCV) 在无家可归者中高度流行，但在这一人群中，仍存在阻碍 HCV 检测和治疗的障碍。我们研究了无家可归者在获取 HCV 护理方面的经历，以了解基于收容所的 HCV 预防和治疗计划的设计。
旧金山一家大型收容所的无家可归者收容客户（10 名女性和 10 名男性）参加了男女分开的焦点小组。焦点小组采用半结构化访谈形式，评估了个人、项目/系统和社会层面普遍进行 HCV 检测和与 HCV 护理联系的障碍和促进因素。对焦点小组访谈进行了转录、编码和分析，采用主题分析。
我们确定了 HCV 检测和治疗的个体层面（对 HCV 感染的知识有限和误解、对医疗保健提供者的不信任、药物使用、精神和慢性医疗条件的共病）、系统层面（收容所工作人员对 HCV 服务的支持有限）和社会层面（无家可归的耻辱感）的关键障碍。参与者描述的 HCV 护理的个人、系统和社会促进因素分别包括内在动机、经济激励、快速 HCV 检测的先前经验和负担得起的直接作用抗病毒 (DAA) 治疗的可用性。
相互关联的个人和社会层面因素是影响无家可归者决定参与 HCV 预防和治疗的主要障碍。针对有 HCV 感染风险或患有 HCV 的无家可归者的综合护理模式解决了其中的许多因素，应包括干预措施，以提高患者对 HCV 的认识和有效治疗的可用性。
