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Services for people with HCV who use homeless shelters

Researchers in Brighton, England, have found that some homeless people are at increased risk for liver disease. Unfortunately, in the experience of the researchers, this vulnerable population may be reluctant to engage with hospital-based services, where monitoring and care of liver diseases usually take place.

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To help remedy this problem, the Brighton researchers established a liver monitoring and care service located in the community that focused on people 40 years and older. Specifically, in late 2015, the researchers, together with doctors and nurses, established a liver care service at two major hostels that catered to homeless people aged 40 and up. At these mini-clinics each participant was asked to do the following:

  • a brief survey about their use of alcohol and street drugs
  • screening for blood-borne viruses
  • specialized ultrasound scans of the liver (Fibroscans)

If participants were found to have chronic hepatitis C virus (HCV) infection and/or significant liver injury arising from HCV infection, they were offered treatment.

So far researchers have enrolled 84 people whose key features at the time of enrollment in the liver care service were as follows:

  • 79% men, 21% women
  • average age – 51 years
  • underlying drivers of liver injury were excessive intake of alcohol, chronic HCV infection or both. About 45% of participants disclosed that they had become addicted to alcohol.
  • 68% of participants disclosed that they had mental health issues
  • 77% of participants disclosed that they had used or currently used street drugs

HCV and liver assessments

  • 36 participants (43%) had HCV infection
  • 27% of participants had what the researchers termed “clinically significant” levels of liver injury
  • 18% had severely injured livers

Putting it all together

The present study of the liver care service should be considered preliminary. However, it shows that a high proportion of people (97%) who use homeless shelters in Brighton are willing to engage in liver care when services are located in the community for their use.

The researchers used Fibroscans to reveal the extent of liver injury in participants. The researchers found that these machines were “perceived [by participants] to be a powerful tool that facilitated patient engagement.”

The researchers encouraged health authorities in other regions to “replicate” their model of providing services to older and vulnerable homeless adults.

At present, only a small proportion of people have started HCV therapy. The researchers will provide an update on the safety and effectiveness of treatment in the future.

Some people with relatively uncomplicated mental health issues are also looked after by clinicians affiliated with the study. However, people with complex mental health conditions and substance use issues are referred to other clinics that specialize in such care.

—Sean R. Hosein

REFERENCE:

Hashim A, Worthley T, Macken L, et al. Enhancing detection and treatment of chronic hepatitis C related liver disease in vulnerable adults through a dedicated homeless hostel-based liver service: Vulnerable Adults Liver Disease Study. In: Program and abstracts of the International Liver Congress, 19-23 April 2017, Amsterdam, the Netherlands. Poster 179.