Theme: Models of Care Year: 2022
Approximately 11,500 people are living with active, untreated hepatitis C virus (HCV) in San Francisco;
an estimated 90% of those are people who inject drugs (PWID). In 2016 multiple community partners
came together to establish End Hep C SF (EHCSF), a multi-sector independent consortium operating
under the principles of collective impact and working toward HCV elimination in San Francisco.
Description of model of care/intervention:
Collective impact models bring people together in a structured way to achieve social change. Collective
impact initiatives have five pillars—a common agenda, shared measurement, mutually reinforcing
activities, continuous communication, and a strong backbone. Given the disproportionate impact of HCV
on marginalized groups, EHCSF leadership values the meaningful involvement of impacted community
members. Accordingly, EHCSF undergoes an annual multimodal evaluation, combining a results-based
accountability approach to quantitative data with a qualitative approach, to assess EHCSF adherence to
the collective impact model, meaningful community leadership, and elimination outcomes.
EHCSF 2021 outcome data reveal encouraging trends following COVID-19-related disruptions; HCV
treatment initiation for low-income San Franciscans increased by 12% in 2021 relative to 2020, while
HCV-related mortality decreased 27% from 2020 to 2021. Process evaluation data revealed consistency
in the initiative’s shared vision and strong backbone, but challenges around communication and
representation efforts persist.
Conclusion and next steps:
Outcome data alone do not tell the complete story about the functioning of HCV elimination efforts.
Supplementing quantitative data with qualitative data specifically on initiative process compels a more
comprehensive understanding of initiative functioning and adherence to collective impact principles.
EHCSF leadership will address process challenges around communication and representation with
targeted outreach efforts in 2022.
Disclosure of Interest Statement:
Dr. Facente has received consulting fees from Gilead Sciences for unrelated work. No pharmaceutical
grants were received in the development of this work, though Gilead Foundation and AbbVie Foundation
have provided grant support to End Hep C SF for other efforts.