Liver Health In Surrey Homeless Populations. Outcomes Of Pop-Up Assessment Clinics Delivered During Covid-19

IntroductionHomeless populations suffer an increased burden of morbidity as compared to the general population, with significant barriers to healthcare access The Office for National Statistics (ONS) reports premature mortality in this population at a mean age of 45, thirty years earlier than the general population, including a significant burden of drug-related deaths (40%) and alcohol-related deaths (12%) (ONS data 2018) During the initial COVID-19 pandemic with temporary accommodation provided by local councils, there was a unique opportunity to engage this population to assess liver health in Surrey MethodPop-up clinics were set up in venues hosting homeless populations in Guildford and Woking between May and June 2020 inclusive Patients completed a self-assessment questionnaire detailing liver risk factors, including drug and alcohol misuse, and medical history Liver health was assessed through Fibro Scan technology and hepatitis C (HCV) antibody testing was offered to all Food vouchers were used as an incentive for participation and volunteers from the Hepatitis C Trust supported the hospital team ResultsA total of 124 patients were assessed over 7 days, of whom 90 were male (73%) 65% ‘White British’ (n=80), 16% ‘White Other’ (n=20) and 7 2% were from BAME groups (n=9) 37% (n=46) had at least 1 underlying condition of which mental health was the most frequent (n=25) followed by chronic lung disease (n=9) Drug and alcohol assessment demonstrated that 66% (n=82) were current recreational drug users, of whom 10 were currently injecting drugs, and 17 had injected in the last 5 years Over half (n=69) indicated a history of alcohol excess, of whom 15 consumed 90 units/week The average Fibro Scan liver stiffness was 6 6 kPa (range 2 9 kPa to 72 8 kPa) with an average CAP of 240 13 patients required further management within local hepatology services, with 8 patients testing positive for HCV antibodies, 3 with advanced fibrosis and 2 with cirrhosis secondary to ALD and NAFLD respectively ConclusionThe housing of homeless people in Surrey during the COVID-19 pandemic allowed for evaluation of the liver health and health promotion including harm reduction advice in this marginalised community Patient questionnaires demonstrated high levels of drug and alcohol misuse Our pop-up clinics identified an unmet liver healthcare need in 10% (13/124) Targeted outreach to this hard-to-reach population enabled initial engagement Future plans include weekly clinics in day centres and periodic education events