182990 Implementation and evaluation of a homeless hepatitis C clinic: An academic and community partnership

Tuesday, October 28, 2008: 3:30 PM

Catherine Rongey, MD, MSHS , Gastroenterology Hepatology, University of Souther California, Los angeles, CA
Paul Gregerson, MD, MBA , JWCH Institute, Los Angeles, CA
Gery Ryan, PhD , RAND Corporation, Santa Monica, CA
Lillian Gelberg, MD, MSPH , Family Medicine, University of California, Los Angeles, Los Angeles, CA
Purpose: Employing the principles of equity, co-learning and balance between research and action, we describe the formation of the Los Angeles Homeless Hepatitis C Coalition (HHC), our progress in the operation of and evaluation of a homeless hepatitis C (HCV) treatment intervention.

Background: There is an estimated 30% HCV seroprevalence in the homeless with few to none receiving treatment.

Barriers to care include poor patient and community resources, provider bias, high population prevalence of psychiatric and medical co-morbidities and substance abuse.

Methods: After negotiating resources and funding, the coalition developed the clinic structure, clinical decision tree, delineated expected outcomes and developed an evaluation design. Semi-structured and structured interviews of the patients and providers captured the patient, provider and community experience. In chart abstraction, we documented patient visit and treatment compliance, clinical and laboratory treatment side effects.

Results: We created a social and medical care model focused on patient and community empowerment. We have treated 16 HCV infected homeless persons. Treatment and visit compliance has been above 80% with appropriate treatment response. Four patients emerged in leadership roles.

Conclusions: We describe the successful partnership of community and academic medicine and hope to provide a replicable model. We will present the results of our interviews and chart abstraction. Careful patient selection, accessible providers, emphasis on patient leadership and empowerment, coordination of social support agencies and support of clinic administrative and physician leaders were identified as key components to a successful initiation of a homeless HCV treatment intervention.

Learning Objectives:
1. Describe community based participatory research methods in implementation and evaluation of a homeless hepatitis C clinic 2. Identify important components in developing and sustaining a homeless hepatitis C clinic

Keywords: Community-Based Health Care, Homeless Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary investigator.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.