ArticleJHEP reports : innovation in hepatology2024
A novel multisite model to facilitate hepatitis C virus elimination in people experiencing homelessness.
Article in JHEP reports : innovation in hepatology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
2 citing papers in PubMed.
- Emergency Department Opt-Out Testing for Hepatitis B: A Two-Year UK Multicentre Evaluation of Outcomes Across Seven Sites.Liver international : official journal of the International Association for the Study of the Liver · 2026Article
- Prevalence and risk factors of viral hepatitis and HIV among people experiencing homelessness in Germany based on a nationwide study.Scientific reports · 2025Article
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background & Aims: 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. Methods: 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. Results: 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, Conclusion: The END C study endorses a multisite decentralised service for PEH enabling excellent linkage to care, high SVR12 rates, and significant improvements in generic and liver specific HRQoL, all being achieved at modest costs. Such services are paramount to help achieve HCV elimination. Impact and implications: In people experiencing homeless, we found a high prevalence of HCV, alcohol, and substance misuse including overdoses and mental health issues. Despite this, an integrated and decentralised service resulted in excellent linkage to care with high SVR12 rates. Even in this complex cohort with multiple comorbidities, SVR12 was associated with significant improvements in both generic and liver specific HRQoL. This was all achieved at modest costs in a community setting. Such models of care are feasible, easy to replicate, and essential if we are to achieve HCV elimination.
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