A Mixed Methods Evaluation of an Innovative Peer+Clinician Outreach HCV Model of Care for Unstably Housed Populations in London, UK, Using the Integrated HCV Candidacy Framework

Author: Binta Sultan John Gibbons Indrajit Ghosh Julian Surey

Theme: Models of Care Year: 2022

HCV elimination efforts are increasingly being focused on community-based models to reach the
most socially excluded patients. Despite this, people affected by homelessness still have poorer HCV
treatment outcomes. An innovative peer + clinician outreach, trauma informed model of care was
developed and initiated in London, UK. Unstably housed patients who had either been lost to follow
up following a positive HCV antibody test or recently diagnosed were referred to the team between
May 2020-February 2022. Data was routinely collected about demographics, social care and other
health needs, treatment outcomes and mortality.
Description of model of care/intervention:
A highly trained peer support worker working with an Infectious Diseases physician within a
specialist homeless and inclusion health service. All healthcare interactions: clinical assessment,
blood tests, provision of HCV medication and follow-up occurred in the outreach setting, with visits
to homelessness settings (hostel, day centres and street outreach).
121 patients were referred to the service. The majority referred by local drug treatment centres
(73/121), 80/121 were male, median age 50 years, 105/121 were HCV RNA+ve, 6 had only HIV
infection (12 HIV in total), 6/121 had HIV and 3/121 HBV co-infection, 106/121 were using drugs,
35/121 had problematic alcohol use. The team were able to contact 116/121 patients. 99/105 HCV
RNA+ve patients were engaged and referred for treatment, 95/99 approved to start treatment
81/99 started treatment (4 due to start treatment, 6 awaiting assessment), 75/99 completed 4
weeks of treatment, 64/99 completed a full course of treatment (10 still on treatment, 2 did not
complete full treatment, but achieved SVR12, 3 died, 7 treatment failures, 9 lost to follow up after
starting treatment and 6/121 died.
Conclusion and next steps:
A high proportion of patients transitioned through each stage of the HCV cascade of care. This was
achieved through supporting patients with identification of candidacy for HCV care, navigation of
services, supported adjudication by providers and a trauma informed model of care that provided an
enabling service environment.
This is a socially complex population, with a high rate of mortality. This innovative model of peer and
clinician HCV outreach is effective at enabling people affected by homelessness to achieve good
treatment outcomes.

Disclosure of Interest Statement:
Binta Sultan is funded by a National Institution of Health Research Fellowship. There are no other
disclosures of interest.

Download abstract