As One Door Closes, Another Opens. Covid-19: A Unique Opportunity To Screen For Hepatitis C In Difficult-To Reach Homeless Populations

IntroductionThe burden of Hepatitis C (HCV) is significant in hard-to-reach populations in whom intravenous drug use (IVDU) is high, including those experiencing homelessness Despite experiencing the highest risk for HCV, personal and systemic factors make homeless people underserved by standard healthcare provision and engagement is difficult The COVID-19 pandemic provided a unique opportunity to engage with at-risk populations offered temporary government-funded housing MethodThe Surrey ODN team working in partnership with the Hepatitis C Trust secured permission from the County Council CCG and Hospital Trust to undertake one-day testing clinics in temporary housing venues, hotel car parks and day centres across Guildford and Woking Social distancing was observed and PPE available for close patient contact Clients completed a questionnaire detailing HCV risks, after which an oral swab point-of-care test was performed for HCV antibodies (Oraquick®) Patients were offered a Fibro Scan whilst awaiting results and those with a positive swab result had further tests to detect HCV viral load A food voucher was used as an incentive for testing ResultsA total of 124 patients were tested over 7 days across all sites Of these, 90 (73%) were male, average age 39 7 years The population was predominantly White British (84%), with a minority of other backgrounds;Polish 10 (8%), other European 4 (3%), and BAME 9 (7 2%) 82 (66%) disclosed a history of recreational drug use with 10 (8%) currently injecting drugs and 17 (14%) injecting in the last 5 years Health questionnaires identified 1 HCV risk factor in 45 (36%), 2 in 35 (28%), and 3 or more in 16 (13%) Of the 124 patients tested, 8 (6 5%) were positive for HCV antibodies We identified and treated 1 active HCV infection, and spontaneous viral clearance in 3 current PWIDs We were able to re-engage and confirm sustained virological response (SVR) in 4 patients who had been lost to follow-up prior to end of treatment and SVR ConclusionThe burden of HCV infection falls disproportionally on those experiencing homelessness and substance misuse We were able to use the COVID-19 pandemic to reach at-risk populations to screen for HCV, facilitate micro-elimination and reinforce harm reduction advice Our homeless population have multiple risk factors for HCV, with HCV antibodies detected in 6 5% as compared to an estimated prevalence of 0 14% across Surrey (gov uk ODN-profile tool) New injection networks may emerge given lockdown housing locations and retesting after lockdown will be crucial