Advanced Hepatitis C Testing Utilized in Philadelphia Clinic Targeting Homeless Patients
Methods/Issues: About 1.6% of the American population is infected with HCV. But, rates in certain subgroups are significantly higher. One study of homeless veterans found a 41.7% HCV antibody seroprevalence among homeless veterans, showing many were exposed to HCV, but no information about how many were chronically infected. General estimates predict that 15-25% of patients HCV antibody positive clear their virus on their own and 75-85% are chronically infected. But data about the general homeless populations are limited. We implemented routine HCV testing at Mary Howard Health Center (MHHC), which treats an entirely homeless population. Patients are tested because they had been or are currently displaced, even if for one night. All patients qualify and are offered a test at their medical or family planning appointment. HCV antibody test with reflex to confirmatory RNA test is drawn on-site to determine chronic cases. Chronic patients are followed from diagnosis through medical evaluation. A Linkage to Care Coordinator facilitates the transition and retention in specialist care.
Results: From October 2012 through October 2013, MHHC tested 527 patients; 41 (8.0%) had positive antibody tests; 36 (87.8%) had RNA tests; 25 (69.4%) were chronic; 19 (76.0%) were linked to care; 11 (30.6%) cleared the virus on their own.
Conclusions: Regardless of risk factor, rates of HCV are higher amongst homeless individuals than others and warrants more testing. More patients clear the virus on their own than expected. Universal HCV testing is better for high-risk communities than risk-based testing. HCV reflex tests ensure chronic HCV diagnosis and linkage to care.
Learning Areas:Advocacy for health and health education
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related nursing
Analyze HCV epidemiology among a homeless population in Philadelphia, PA; Formulate a model to implement HCV testing targeting populations with high HCV prevalence; Discuss the need for HCV testing among homeless individuals.
Keyword(s): Health Disparities/Inequities, Hepatitis C
Qualified on the content I am responsible for because: I am qualified because I designed and implemented the HCV testing program at Mary Howard Health Center. I oversee project progress, data management and work very closely with Mary Howard Health Center staff to ensure project effectiveness and efficiency. I work directly with data to ensure its integrity, accuracy and all analysis is reliable and credible. My scientific areas of interest are systems-level health interventions targeting disenfranchised populations.
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.