A novel multisite model to facilitate hepatitis C virus elimination in people experiencing homelessness

Only a handful of countries are on target to achieve elimination of HCV by 2030. People experiencing homelessness (PEH) remain an important HCV reservoir. The END C study evaluated clinical, patient reported, and health economic outcomes of a decentralised integrated model. This prospective study assessed a decentralised regional service based at multiple homeless sites in southeast England. Novel linkage-care strategies were used. We assessed generic and liver specific health-related quality of life (HRQoL) (SF-12v2; EQ-5D-5L, and SFLDQol) pre-/post-HCV treatment, and cost per HCV case detected and cured. The primary outcome was sustained virological response (SVR12) in the intention-to-treat (ITT) population. We recruited 418 individuals with mean age 44.45 ± 10.6 years, 78% were male, 74% were currently homeless, current injecting drug use or alcohol use was 25% and 65%, respectively. Prevalence of cirrhosis (liver stiffness measurement ≥12 kPa) was 12%. A total of 28% (n = 116) were HCV PCR-positive of whom 105 individuals received direct acting antiviral treatment. The ITT SVR12 rates were 81% (95% CI 72%–88%), the only predictor of SVR12 was >80% treatment adherence (OR 20.69, 95% CI 6.227–68.772, p