Clinical Scorecard: Streamlined Hepatitis C Virus Testing and Treatment Protocol for Homeless Individuals Who Inject Drugs
At a Glance
Category
Detail
Condition
Hepatitis C virus (HCV) infection
Key Mechanisms
Simplified HCV testing and treatment algorithms with integrated care via mobile medical units (MMUs)
Target Population
Unhoused people who inject drugs (PWID)
Care Setting
Mobile medical clinics and syringe service programs in urban US settings
Key Highlights
HCV disproportionately affects PWID, especially those experiencing homelessness, who face barriers to testing and treatment.
Simplified algorithms and MMUs can facilitate faster treatment initiation but face challenges with retention and follow-up.
Overall treatment initiation, retention, and cure rates remain low, highlighting the need for improved test-and-treat models.
Guideline-Based Recommendations
Diagnosis
Use simplified HCV testing algorithms including point-of-care HCV RNA assays for marginalized populations.
Integrate HCV testing with existing harm reduction services such as needle and syringe programs and opioid agonist therapy sites.
Management
Deliver integrated HCV care via mobile medical units to improve access among unhoused PWID.
Employ direct-acting antiviral (DAA) therapy, which is highly effective and safe for PWID.
Monitoring & Follow-up
Monitor treatment initiation within 6 months of diagnosis.
Assess treatment completion and sustained virologic response at 12 weeks (SVR12).
Risks
High loss to follow-up and retention challenges in mobile care models.
Competing priorities and transportation barriers among unhoused PWID.
Patient & Prescribing Data
Unhoused PWID with confirmed HCV RNA positivity
33% initiated treatment via MMU model versus 24% with usual care; treatment completion and SVR12 rates were higher in usual care but differences were not statistically significant.
Clinical Best Practices
Implement simplified, integrated HCV testing and treatment protocols tailored to marginalized populations.
Utilize mobile medical units to reduce barriers and provide rapid access to care.
Combine HCV care with harm reduction services to enhance linkage and retention.
Develop approaches approximating test-and-treat models to improve treatment initiation and completion.
by Christian B Ramers, Natalie Vawter, Adam Northrup, Stacey L Klaman, Sydney V Lewis, Aaron Tam, Carolina Del Aguila, Robert Lewis, Blanca Mendez, Letty Reyes, Eva Matthews, Sarah Rojas, Job G Godino
