TO TREAT OR NOT TO TREAT: BIAS AND BARRIERS TO HEPATITIS C CARE AMONG THE HOMELESS OF SKID ROW.

Abstract

Background The prevalence of hepatitis C virus (HCV) among the homeless population occupying the Skid Row District of Los Angeles County is an estimated 54%, compared with a national prevalence of 1.6%. Yet although the need for treatment among the homeless is dire, almost none receive treatment for the disease. Purpose The purpose of this study is to illuminate the systemic barriers to HCV treatment for the homeless. Methods We conducted a secondary analysis of a cross-sectional survey of 534 homeless adults in Skid Row selected by two-stage probability sampling in 2003. Comparing LA County HCV treatment eligibility guidelines to consensus-based guidelines from the American Association for the Study of Liver Diseases (AASLD), our study participants were categorized into four groups: eligible for treatment, eligible for treatment at the provider9s discretion, contraindicated for treatment, and no treatment guidance offered. Results In our sample of 534 homeless patients, 28% were HCV positive. Of these, only 5% would be offered treatment, 33% would be offered treatment at the discretion of the provider, and 32% were deemed ineligible for treatment using AASLD guidelines. For the 30% of patients who were suffering from severe mental illness or drug use without rehabilitation, no recommendations for treatment were offered at all. Not a single homeless person, by contrast, would be deemed eligible for treatment under LA County guidelines. Conclusions Evidence-based revisions to LA County and AALSD guidelines are recommended to better meet the unique treatment needs of the HCV-positive homeless community.