Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom.
Hepatitis C Trust, London, United Kingdom.
Am J Gastroenterol. 2023 Jun 1;118(6):991-1000. doi: 10.14309/ajg.0000000000002041. Epub 2022 Sep 30.
Given the hepatitis C virus (HCV) burden and despite curative treatments, more efforts focused on scaling-up testing and treatment in homeless populations are needed. This project aimed to implement education and flexible on-site HCV testing, treatment, and follow-up for a homeless population in south London and to evaluate engagement, therapy initiation, and cure rates.
A mobile unit (van) for on-site HCV education, screening, treatment, and follow-up was placed on the street in a well-known homeless population areas from January 2018 to September 2021. Homeless was defined as living in temporary housing (hostel/hotel-based) or living on the street (street-based). Sociodemographic status, risk factors, comorbidities, concomitant medication, and data related with HCV treatment were recorded. Univariable and multivariable modeling were performed for treatment initiation and sustained virological response (SVR).
Nine hundred forty homeless people were identified and 99.3% participated. 56.2% were street-based, 243 (26%) tested positive for HCV antibody, and 162 (17.4%) were viremic. Those with detectable HCV RNA had significantly more frequent psychiatric disorders, active substance use disorders, were on opioid agonist treatment, had advanced fibrosis, and had lower rates of previous treatment in comparison with undetectable HCV RNA. Overall treatment initiation was 70.4% and SVR was 72.8%. In the multivariable analysis, being screened in temporary housing (odds ratio [OR] 3.166; P = 0.002) and having opioid agonist treatment (OR 3.137; P = 0.004) were positively associated with treatment initiation. HCV treatment adherence (OR 26.552; P < 0.001) was the only factor associated with achieving SVR.
Promoting education and having flexible and reflex mobile on-site testing and treatment for HCV in the homeless population improve engagement with the health care system, meaning higher rates of treatment initiation and SVR. However, street-based homeless population not linked with harm reduction services are less likely to initiate HCV treatment, highlighting an urgent need for a broad health inclusion system.
鉴于丙型肝炎病毒（HCV）的负担，尽管有了治愈方法，但仍需要更加努力地扩大对无家可归人群的检测和治疗。本项目旨在为伦敦南部的无家可归人群实施 HCV 教育、灵活的现场检测、治疗和随访，并评估参与度、治疗启动和治愈率。
从 2018 年 1 月至 2021 年 9 月，一辆移动单元（面包车）被安置在一个知名无家可归人群区域的街道上，用于 HCV 教育、筛查、治疗和随访。无家可归者被定义为居住在临时住房（宿舍/酒店式）或居住在街头（街头）的人。记录社会人口统计学状况、风险因素、合并症、伴随药物以及与 HCV 治疗相关的数据。对治疗启动和持续病毒学应答（SVR）进行单变量和多变量建模。
共确定了 940 名无家可归者，其中 99.3%参与了研究。56.2%为街头无家可归者，243 人（26%）HCV 抗体检测呈阳性，162 人（17.4%）存在病毒血症。与 HCV RNA 不可检测的人相比，那些 HCV RNA 可检测的人更频繁地出现精神障碍、物质使用障碍、正在接受阿片类激动剂治疗、纤维化程度更高，且以前接受治疗的比例更低。总体治疗启动率为 70.4%，SVR 为 72.8%。在多变量分析中，在临时住房中筛查（优势比 [OR] 3.166；P = 0.002）和接受阿片类激动剂治疗（OR 3.137；P = 0.004）与治疗启动呈正相关。HCV 治疗依从性（OR 26.552；P < 0.001）是与 SVR 相关的唯一因素。
在无家可归人群中推广教育并提供灵活的现场 HCV 检测和治疗，提高了他们对医疗保健系统的参与度，从而提高了治疗启动率和 SVR 率。然而，与减少伤害服务没有联系的街头无家可归者不太可能开始 HCV 治疗，这突出表明需要建立一个广泛的健康包容体系。
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