Researchers of the END C study evaluated the effectiveness of a decentralized, integrated model for hepatitis C virus (HCV) treatment in people experiencing homelessness (PEH) in southeast England. The study involved 418 participants, with a high prevalence of substance misuse and alcohol use. Of the 116 individuals who were HCV polymerase chain reaction-positive, 105 received direct-acting antiviral treatment, resulting in a sustained virological response (SVR12) rate of 81%. The key factor for achieving SVR12 was over 80% treatment adherence. The researchers also found significant improvements in health-related quality of life (HRQoL) post-treatment, particularly in general and mental health, liver disease symptoms, distress, and loneliness. The cost per case detected was £359, and the cost per case cured was £257.

The study highlights the success of a decentralized, multisite service for PEH in achieving high SVR12 rates and significant improvements in HRQoL, all at modest costs. Despite the complex health challenges faced by this population, including substance misuse and mental health issues, the model demonstrated excellent linkage to care and positive health outcomes. The study underscores the feasibility and scalability of such care models, which are crucial for achieving HCV elimination goals, especially in high-risk and underserved populations.

Reference: Mourad A, McGeer R, Gray E, et al. A novel multisite model to facilitate hepatitis C virus elimination in people experiencing homelessness. JHEP Rep. 2024;6(11):101183. doi: 10.1016/j.jhepr.2024.101183.