Access and Health Equity
Groups Around the World Work to Eliminate Hepatitis C by Meeting People Where They Are
Stories@Gilead - March 02, 2023 - 4 min read
Every Friday for more than two years, a community church in North Wales, U.K., would transform into a one-stop shop of social services for people experiencing homelessness. Everything from housing to haircuts, mental health services and foot care by local podiatrists were offered to at least 70 people who showed up specifically for these services each week.
It was here that lead blood-borne virus pharmacist Sarah Hulse and her colleagues at the Betsi Cadwaladr University Health Board set up a point-of-care diagnostic device that could deliver hepatitis C (HCV) test results in less than an hour. This enabled pharmacists to assess patients and prescribe medication for treatment to begin as soon as possible.
Previous testing methods in the community took at least a week for results to come back, and there were multiple appointments for treatment in settings that weren't convenient.
“Individuals would have to return to a hospital or clinic for treatment, but they didn’t come,” explains Sarah. “Engaging a population that doesn’t have stable housing, reliable communication and transportation is a big challenge, thus delivering care closer to where the need was rather than asking patients to come to us was critical.”
HCV is a virus that attacks the liver and can cause cirrhosis and liver cancer, but it can be prevented with proper interventions, as well as treated and cured with today’s medicines. In fact, Gilead helped to pioneer medicines to cure HCV and is committed to addressing the unmet needs of people living with viral hepatitis. Because HCV is associated with drug use, there has historically been stigma around it.
Micro-Elimination Programs Help Overcome Barriers to Treatment
Among the biggest barriers to testing and treatment are stigma and access, and experts believe that tailored outreach and treatment approaches are key to meeting people where they are and ensuring specific populations get the care they need. The global hepatitis community endorses micro-elimination programs that strategically target traditionally difficult-to-reach populations, such as those experiencing housing instability in North Wales, and Gilead has long supported grantee programs like this that address barriers to care.
In many U.S. regions, mobile treatment centers or syringe exchange programs in vans have proven effective. But for people living in the Appalachian Mountains areas, such as Ohio or Pennsylvania, there are fears around others knowing about an HCV diagnosis. That’s why Kathi Scholz, an infectious disease nurse practitioner at Central Outreach, teamed up with the director of a methadone clinic in Pennsylvania to create The Cure Squad, another Gilead grantee.
“We leverage community partnerships within other programs to test and treat people,” says Kathi. "It makes no difference to us how you got it, where you got it or when you got it. We just want to cure your hep C.”
The Cure Squad provides outreach to various recovery and treatment centers, homeless shelters, transitional homes and other non-clinical settings to test people for HCV, HIV and sexually transmitted infections (STIs). As is the case in North Wales, this enables faster test turn-around times in order to ensure a path to care.
“Storing medication is also a challenge for people with unstable housing situations,” explains Kathi. “We’ve found that lanyards help keep their medications safe, and blister packs, as opposed to pill bottles, help with treatment adherence.”
In North Wales, the micro-elimination efforts were so successful in the initial rollout that the program was expanded across the region. The pandemic temporarily stopped the one-stop services offered at the church, but since the program launched at the end of 2019, nearly 100 people have received treatment.
"Being cured of HCV has had a really life-changing impact on a lot of the patients,” says Sarah.