Results of a Model of Delivering Hepatitis C Care in a Homeless Metropolitan Population in England.

INTRODUCTION: Given the hepatitis C virus (HCV) burden and despite curative treatments, more efforts focused on scaling-up testing and treatment in homeless populations are needed. This project aimed to implement education and flexible on-site HCV testing, treatment, and follow-up for a homeless population in south London and to evaluate engagement, therapy initiation, and cure rates. METHODS: A mobile unit (van) for on-site HCV education, screening, treatment, and follow-up was placed on the street in a well-known homeless population areas from January 2018 to September 2021. Homeless was defined as living in temporary housing (hostel/hotel-based) or living on the street (street-based). Sociodemographic status, risk factors, comorbidities, concomitant medication, and data related with HCV treatment were recorded. Univariable and multivariable modeling were performed for treatment initiation and sustained virological response (SVR). RESULTS: Nine hundred forty homeless people were identified and 99.3% participated. 56.2% were street-based, 243 (26%) tested positive for HCV antibody, and 162 (17.4%) were viremic. Those with detectable HCV RNA had significantly more frequent psychiatric disorders, active substance use disorders, were on opioid agonist treatment, had advanced fibrosis, and had lower rates of previous treatment in comparison with undetectable HCV RNA. Overall treatment initiation was 70.4% and SVR was 72.8%. In the multivariable analysis, being screened in temporary housing (odds ratio [OR] 3.166; P = 0.002) and having opioid agonist treatment (OR 3.137; P = 0.004) were positively associated with treatment initiation. HCV treatment adherence (OR 26.552; P < 0.001) was the only factor associated with achieving SVR. DISCUSSION: Promoting education and having flexible and reflex mobile on-site testing and treatment for HCV in the homeless population improve engagement with the health care system, meaning higher rates of treatment initiation and SVR. However, street-based homeless population not linked with harm reduction services are less likely to initiate HCV treatment, highlighting an urgent need for a broad health inclusion system.

Hepatitis B: prevalence and pathophysiology.

Chronic hepatitis B is a growing worldwide public health issue. Its prevalence and the mode of transmission of the virus varies greatly between parts of the world. Prevalence is rising in the UK due to an increase in migration from areas with a high prevalence of chronic hepatitis B. This article, the first of a two-part series, discusses the prevalence and pathophysiology of chronic hepatitis B, as well as recommendations for screening high-risk groups and immunisation against the disease. Part two discusses the management of the virus.

Management of chronic hepatitis B virus.

The management of chronic hepatitis B is complex due to its four disease stages. Monitoring is often required to inform future management; not all patients will require interventions. The long-term goals of treatment are to halt disease progression and to prevent cirrhosis, hepatocellular carcinoma and liver failure. A number of guidelines are available, including those issued by the European Association for the Study of Liver Disease and recently published National Institute of Health and Care Excellence guidelines. This article, the second in a two-part series, discusses the assessment and management of chronic hepatitis B in light of recent guidelines and the role of nurses in caring for patients with CHB. Part 1 looked at the prevalence and pathophysiology of chronic hepatitis B, recommendations for screening high-risk groups and immunisation.