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Int J Drug Policy. 2019 Apr 10. pii: S0955-3959(19)30077-5. doi: 10.1016/j.drugpo.2019.02.012. [Epub ahead of print]

Quantitative evaluation of an integrated nurse model of care providing hepatitis C treatment to people attending homeless services in Melbourne, Australia.

Author information

1
Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia. Electronic address: brendan.harney@burnet.edu.au.
2
Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
3
Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia.
4
Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia.
5
Star Health, 341 Coventry St, South Melbourne, Victoria, 3205, Australia; Launch Housing, 52 Haig St, Southbank, Victoria, 3205, Australia.
6
Department of Infectious Diseases, Alfred Health & Monash University, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Disease Elimination Program, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Melbourne, Australia.

Abstract

BACKGROUND:

The prevalence of hepatitis C virus (HCV) has been reported to be high among people experiencing homelessness. People who are homeless often have multiple needs that may take precedence over HCV testing and treatment. We quantitatively evaluated the outcomes of a service providing HCV treatment to people attending homeless services.

METHODS:

Clients attending homeless services were referred to a nurse specialising in HCV-related care. The nurse provided HCV testing, education and case-management while prescriptions were provided by an affiliated doctor. Logistic regression was used to explore factors associated with treatment commencement.

RESULTS:

Fifty-two clients referred (78%) underwent testing, thirty-nine were HCV-RNA positive among whom 18 (46%) reported sleeping rough and 29 (74%) reported injecting drug use; 66% had injected less than three months ago. Twenty-four (62%) clients commenced treatment, of whom thirteen (54%) had a sustained virological response test; all were cured. Treatment commencement was lower among people who reported sleeping rough (aOR 0.15, 95%CI 0.029-0.73). There was no difference in treatment commencement based on injecting drugs (aOR 1.06, 95%CI 0.21-5.2).

CONCLUSION:

Most clients' commenced treatment and the majority were successfully cured using a dedicated nursing service. Clients who reported sleeping rough may still face personal and/or system level barriers to HCV treatment.

KEYWORDS:

Hepatitis C; Homeless; Injecting drug use

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