A community-based primary care treatment program achieved a 97% sustained virologic response rate at 12 weeks among homeless adults with hepatitis C, according to a Research Letter to the Editor published online in JAMA Internal Medicine.

An estimated 44% of homeless adults have hepatitis C and face many barriers to effective treatment. Investigators described their experience with the Boston Health Care for the Homeless program during an 18-month period in which 64 such patients received oral direct-acting antivirals as part of integrated primary care services. Most were men, and the mean age was 55 years, said Joshua A. Barocas, MD, of the division of infectious diseases, Massachusetts General Hospital, Boston, and his associates.

Patients were selected for the therapy by clinicians – primary care physicians and nurse practitioners – based in part on their adherence to previous medical appointments. They received weekly phone calls from a care coordinator, and they were not required to maintain sobriety to remain eligible for Medicare or Medicaid coverage for the treatment.

Among the study participants, 62 of 64 (97%) achieved a sustained virologic response at 12 weeks. Only 13% reported missing more than three doses of oral antivirals. Viral testing showed genetic mutations conferring resistance to treatment in one of the two patients who did not achieve SVR, the investigators said ( JAMA Intern Med. 2017 Apr 10. doi: 10.1001/jamainternmed.2017.0358 ).

“These findings demonstrate that with a dedicated program for treating HCV in homeless and marginally housed adults in a primary care setting, it is possible to achieve outcomes similar to those of clinical trials and other cohorts, despite significant additional barriers and competing priorities to health care faced by this population,” Dr. Barocas and his associates said.

The National Institute on Drug Abuse supported the study. Dr. Barocas and his associates reported having no relevant disclosures.


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