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

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.