Advanced Hepatitis C Testing Utilized in Philadelphia Clinic Targeting Homeless Patients

Objective: Demonstrate the epidemiology of HCV at one FQHC in Philadelphia, PA, with an entirely homeless patient population.

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.