Adherence to Hepatitis C Therapy in a Shelter-Based Education and Treatment Model Among Persons Experiencing Homelessness.

Abstract

Medication adherence is a common reason for treatment deferment in persons experiencing homelessness. We evaluated adherence to hepatitis C virus (HCV) therapy following HCV education in a shelter-based care model. Prospective study conducted at 4 homeless shelters in Minneapolis, Minnesota and San Francisco, California from November 2018 to January 2021. Sixty-three patients underwent HCV education and treatment. Multivariable modeling evaluated factors associated with (1) medication and (2) overall (composite score of medication, laboratory, and clinic visit) adherence. Median age was 56 years; 73% of participants were male, 43% were Black, 52% had psychiatric illness, and 81% used illicit drugs and 60% used alcohol in the past year. Following education, 52% were extremely confident in their ability to be adherent to HCV therapy. Medication adherence by patient and provider report was 88% and 48%, respectively, and 81% achieved HCV cure. Active alcohol use was associated with less confidence in medication adherence (43% vs 78%, P = .04). Older age was positively (coefficient = 0.3) associated with overall adherence to HCV treatment whereas prior therapy was associated with both medication (odds ratio, 0.08) and overall treatment (coefficient = -0.87) nonadherence. Despite imperfect adherence, sustained virologic response rates were still high. Expanding opportunities to treat persons experiencing homelessness in a structured and supportive setting is critical to HCV elimination efforts.