The National Virus Hepatitis Action Plan of 2017-20 identifies the homeless as a priority population for hepatitis C virus (HCV) interventions. In Los Angeles’s Skid Row, an estimated quarter of homeless persons suffer from HCV. Despite the advent of well-tolerated oral antivirals, an inequity in treatment access persists for this population as a result of well-documented barriers including fear of stigma, difficulty maintaining appointments, etc. Provision of HCV linkage to care and treatment at sites directly interfacing with this population may reduce barriers and enhance treatment uptake.

Project HEAL (Hepatitis C Engagement and Accessible Linkage) implemented confirmatory HCV screening and linkage to care services at two sites directly serving LA’s Skid Row population—a full-time federally qualified health center and a clinic co-located in a homeless shelter. Linkage to care services were operationalized through a care coordinator who received real-time alerts of all HCV-positive antibody cases through EMR integration with an internal database. This system improvement allowed the care coordinator to track and engage HCV-positive individuals via phone and in-person at their visits. Early designation of an HCV Champion nurse practitioner mobilized the practice’s capacity to provide community-based treatment.

From 11/2017 to 11/2018, a total of 162 HCV+ individuals were identified. At program end, the proportion of HCV+ who were linked to care increased 43% from a baseline of 60.6% to 86.4%. At time of evaluation, a total of 22 homeless participants had initiated treatment and were eligible for SVR-12 assessment. Ninety-five percent (21/22) had commenced treatment, with 17/21 obtaining SVR-12 while four were lost to follow-up.

Findings from Project HEAL support co-location of HCV screening, linkage, and treatment at homeless shelters and/or facilities providing consistent support to those at high-risk for HCV infection. Preliminary assessment of this pilot program suggests a care coordination model may facilitate progression of vulnerable persons through the HCV care cascade, from screening to cure.