Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.
Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.
J Gen Intern Med. 2023 Jan;38(1):156-164. doi: 10.1007/s11606-022-07708-w. Epub 2022 Jul 25.
Homeless and marginally housed (HAMH) individuals experience significant health disparities compared to housed counterparts, including higher hepatitis C virus (HCV) rates. New direct-acting antiviral (DAA) medications dramatically increased screening and treatment rates for HCV overall, but inequities persist for HAMH populations.
This study examines the range of policies, practices, adaptations, and innovations implemented by Veteran Affairs Medical Centers (VAMCs) in response to Veterans Health Administration (VHA)'s 2016 HCV funding allocation to expand provision of HCV care.
Ethnographic site visits to six US VAMCs varying in size, location, and availability of Homeless Patient-Aligned Care Teams. Semi-structured qualitative interviews informed by the HCV care continuum were conducted with providers, staff, and HAMH patients to elicit experiences providing and receiving HCV care. Semi-structured field note templates captured clinical care observations. Interview and observation data were analyzed to identify cross-cutting themes and strategies supporting tailored HCV care for HAMH patients.
Fifty-six providers and staff working in HCV and/or homelessness care (e.g., infectious disease providers, primary care providers, social workers). Twenty-five patients with varying homeless experiences, including currently, formerly, or at risk of homelessness (n=20) and stably housed (n=5).
All sites experienced challenges with continued engagement of HAMH individuals in HCV care, which led to the implementation of targeted care strategies to better meet their needs. Across sites, we identified 35 unique strategies used to find, engage, and retain HAMH individuals in HCV care.
Despite highly effective, widely available HCV treatments, HAMH individuals continue to experience challenges accessing HCV care. VHA's 2016 HCV funding allocation resulted in rapid adoption of strategies to engage and retain vulnerable patients in HCV treatment. The strategies identified here can help healthcare institutions tailor and target approaches to provide sustainable, high-quality, equitable care to HAMH individuals living with HCV and other chronic illnesses.
无家可归和边缘住房（HAMH）人群与有住房的人群相比，存在显著的健康差距，包括更高的丙型肝炎病毒（HCV）感染率。新型直接作用抗病毒（DAA）药物大大提高了 HCV 总体筛查和治疗率，但 HAMH 人群仍存在不平等现象。
本研究考察了退伍军人事务部医疗中心（VAMC）为响应退伍军人健康管理局（VHA）2016 年 HCV 资金分配以扩大 HCV 护理服务而实施的一系列政策、实践、调整和创新。
对六个美国 VAMC 进行了人种学现场访问，这些 VAMC 的规模、地理位置和无家可归患者护理团队的可用性各不相同。采用 HCV 护理连续体对提供者、工作人员和 HAMH 患者进行半结构化定性访谈，以了解提供和接受 HCV 护理的经验。半结构化现场记录模板捕捉临床护理观察。对访谈和观察数据进行分析，以确定支持为 HAMH 患者提供量身定制的 HCV 护理的跨领域主题和策略。
56 名从事 HCV 和/或无家可归护理的提供者和工作人员（例如传染病提供者、初级保健提供者、社会工作者）。25 名有不同无家可归经历的患者，包括目前、以前或有 homeless 风险的（n=20）和稳定住房的（n=5）。
所有站点都面临着继续让 HAMH 个体参与 HCV 护理的挑战，这导致实施了有针对性的护理策略，以更好地满足他们的需求。在各个站点，我们确定了 35 种用于寻找、接触和留住 HAMH 个体接受 HCV 护理的独特策略。
尽管有非常有效且广泛可用的 HCV 治疗方法，但 HAMH 个体在获得 HCV 护理方面仍面临挑战。VHA 2016 年 HCV 资金分配导致了快速采用策略来吸引和留住脆弱的 HCV 治疗患者。这里确定的策略可以帮助医疗机构针对提供可持续、高质量、公平的 HCV 护理的方法进行调整和定位，以满足 HAMH 个体的需求。
