A homeless digital Hepatitis C active case detection study with the HepCare project
Background and aims:
In the UK, there has been an expansion of testing for BBVs, and HCV in particular, following recent therapeutic advances, with opportunities in hospital emergency departments, drug treatment services and primary care settings. Unfortunately, many are subsequently lost to follow-up (LFU) often because injecting drug use, high levels of homelessness and incarceration. However, there are strategies to successfully find and re-engage these individuals using a combination of digital active case finding and specialist peer support. The Find&Treat team is a pan-London service that has been providing community healthcare and active case finding interventions to the homeless and other under-served populations successfully for over 10 years. In 2018 the team collaborated with the GILEAD funded Viraemic project, which screened for BBVs, on an opt-out basis, individuals who had presented to the emergency department of a London hospital. Its aim was to enhance case finding and linkage to care of individuals who had tested positive for HCV and that the hospital had been unable to contact using digital databases and outreach peer support
A data was shared hospital were satisfied that they had exhausted all methods of contacting individuals. Of 141 HCV Ag positive individuals in the emergency department, 88 individuals who were not contactable and required linkage to care were given to the Find&Treat team. An initial search of CHAIN, a multi-agency database recording information about people sleeping rough and the wider street population in London was carried out. Information available could be current or last known accommodation or street location, drop in centres visited, contact details, hostels, keyworkers or prison location. This was cross referenced with the Find&Treat patient management system and local contacts and knowledge. The PSW then met with contactable individuals in the community and provide counselling with regards as to their status, in an appropriate setting and with any relevant support staff. Those who consented to the intervention were offered peer support into care and data was collected on treatment initiation, completion and success.
Information was found for 50/89 (56.2%) individuals. 42 were currently homeless, 12 of these street-homeless, 5 were currently injecting drugs and 10 had problematic alcohol use. Of the 50 individuals with digital information, the PSW contacted 25(50%) and carried out over 30 community-based visits, successfully re-engaging 13(52%). 8(32%) were engaged already and 4 (16%) were contacted but lost to follow-up.
There is scope for a service that, by using simple data searches and proven peer support re-engagement, can improve linkage to care in homeless individuals. Once contact had been made by a PSW, a high proportion were successfully linked into care. This service model could be used for other diseases and conditions to improve health outcomes for this marginalised group.