Hepatitis C Management in Street Settings: Insights from Adults Facing Unsheltered Homelessness
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By
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Alizée Natsoulis
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Claire Nussbaum
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Lauren Howard
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Daphne Achilles
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Korrinne Yurick
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Camilo Zaks
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Alexis Coulourides Kogan
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July 16, 2026
Clinical Scorecard: Hepatitis C Management in Street Settings: Insights from Adults Facing Unsheltered Homelessness
At a Glance
| Category | Detail |
|---|
| Condition | Hepatitis C Virus (HCV) Infection |
| Key Mechanisms | Blood-borne virus leading to chronic liver disease, cirrhosis, or hepatocellular carcinoma. |
| Target Population | Adults experiencing unsheltered homelessness. |
| Care Setting | Street medicine model providing primary care in encampments and public spaces. |
Key Highlights
- HCV prevalence among homeless individuals ranges from 10% to 53%.
- Direct-acting antivirals (DAAs) show high cure rates (82%-97%) in sheltered populations.
- Linkage to care remains a significant challenge for unsheltered homeless individuals.
- Street medicine teams are positioned to improve HCV screening and treatment access.
- Medi-Cal Rx policy changes have facilitated HCV treatment access for Medicaid recipients.
Guideline-Based Recommendations
Diagnosis
- Annual HCV screening for adults in high-risk populations.
Management
- Treat uncomplicated HCV according to the Simplified HCV Treatment Algorithm.
Monitoring & Follow-up
- Assess sustained virologic response (SVR) post-treatment.
Risks
- Higher rates of HCV among individuals with injection drug use and homelessness.
Patient & Prescribing Data
Adults aged ≥18 years experiencing unsheltered homelessness.
High engagement in street-based treatment can lead to successful outcomes.
Clinical Best Practices
- Utilize street medicine models to reduce barriers to HCV care.
- Implement reflex testing for HCV RNA and genotype in positive screenings.
- Engage multidisciplinary teams for comprehensive care delivery.
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