Powell Jesse, Ricco Margaret, Naugle Jessica, Magee Catherine, Hassan Hayat, Masson Carmen, Braimoh Grace, Zevin Barry, Khalili Mandana
Department of Medicine, Division of Gastroenterology and Hepatology, Hennepin Healthcare, Minneapolis, Minnesota, USA.
Street Medicine and Shelter Health, San Francisco Department of Public Health, San Francisco, California, USA.
Open Forum Infect Dis. 2021 Sep 25;8(10):ofab488. doi: 10.1093/ofid/ofab488. eCollection 2021 Oct.
Medication adherence is a common reason for treatment deferment in persons experiencing homelessness. We evaluated adherence to hepatitis C virus (HCV) therapy following HCV education in a shelter-based care model.
Prospective study conducted at 4 homeless shelters in Minneapolis, Minnesota and San Francisco, California from November 2018 to January 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.
Median age was 56 years; 73% of participants were male, 43% were 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%, = .04). Older age was positively (coefficient = 0.3) associated with overall adherence to HCV treatment whereas prior therapy was associated with both medication (odds ratio, 0.08) and overall treatment (coefficient = -0.87) nonadherence.
Despite imperfect adherence, sustained virologic response rates were still high. Expanding opportunities to treat persons experiencing homelessness in a structured and supportive setting is critical to HCV elimination efforts.
药物依从性是无家可归者治疗延迟的常见原因。我们在基于庇护所的护理模式中评估了丙型肝炎病毒（HCV）教育后对HCV治疗的依从性。
2018年11月至2021年1月在明尼苏达州明尼阿波利斯和加利福尼亚州旧金山的4个无家可归者庇护所进行前瞻性研究。63名患者接受了HCV教育和治疗。多变量模型评估了与（1）药物治疗和（2）总体（药物、实验室检查和门诊就诊的综合评分）依从性相关的因素。
中位年龄为56岁；73%的参与者为男性，43%为黑人，52%患有精神疾病，81%在过去一年中使用过非法药物，60%使用过酒精。教育后，52%的人对自己坚持HCV治疗的能力非常有信心。患者和提供者报告的药物依从性分别为88%和48%，81%实现了HCV治愈。当前饮酒与对药物依从性的信心较低有关（43%对78%，P = 0.04）。年龄较大与对HCV治疗的总体依从性呈正相关（系数 = 0.3），而既往治疗与药物治疗（比值比，0.08）和总体治疗（系数 = -0.87）不依从有关。
尽管依从性不理想，但持续病毒学应答率仍然很高。在结构化和支持性环境中扩大为无家可归者提供治疗的机会对于消除HCV的努力至关重要。
