2942. Successful Screening, Linkage to Care, and Treatment of Hepatitis C in a Tiny Shelter Encampment on Veterans Affairs Grounds Open Access

Persons experiencing homelessness have a high prevalence of hepatitis C virus (HCV) infection and multiple barriers to diagnosis and treatment. We implemented and evaluated a universal HCV screening and HCV care coordination and treatment program for Veterans living at a tiny shelter encampment on the West Los Angeles Veterans Affairs campus.

Hepatitis C Cascade of Care

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All patients who completed treatment and obtained end of treatment lab work achieved SVR12, excluding Veterans who were lost to follow up (LTFU) and/or non-adherent (NA) (n=5), on treatment (n=4), or SVR12 pending (n=5).

We implemented a low-barrier to entry HCV treatment program for Veterans experiencing homelessness (VEH) that spanned April 2020-Dec 2021 (pre-intervention) and Jan 2022-April 2023 (post-intervention). The intervention involved a novel e-consult direct-to-treatment program facilitated by pharmacists and referral to ID/GI clinics (if ineligible for e-consult) and extensive engagement by encampment providers, including provision of direct-acting antivirals (DAAs) in weekly installments. Prior to the intervention, management was achieved solely through ID/GI clinic referrals. We evaluated HCV prevalence, along with linkage to care, treatment initiation, and sustained virologic response (SVR) of this novel program pre-and post-intervention. Data, including demographics, medical history healthcare visits, and other laboratory values were abstracted from the electronic medical record. Descriptive statistics were used to characterize prevalence of HCV and other covariates.

Of the 704 Veterans who sheltered at the encampment at some point from April 2020-April 2023, 587 underwent HCV antibody screening (83%). Of those, 20% (120/587) were HCV Ab positive and 44% (53/120) had HCV viremia. Median age of those who were viremic was 64 years, 100% were male, 32% (17/53) were Black, 9% (5/53) Hispanic, and 58% (31/53) White. Pre- and post-intervention, 25 and 28 Veterans with HCV viremia were identified, 11 and 21 Veterans were linked to care (44% and 75%), 4 and 20 initiated DAAs (36% and 95%), and 1 and 6 achieved SVR (25% and 30%). Nine patients are currently on treatment (n=4) or pending SVR12 (n=5).

After an intervention involving e-consult and encampment provider engagement in VEH, 75% of Veterans with HCV viremia were linked to care, compared to 44% of Veterans prior to the intervention. Our program demonstrates the feasibility of encampment-based HCV screening, linkage to care and treatment.

Debika Bhattacharya, MD, MSc, Gilead Sciences: Grant/Research Support