{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T16:44:38Z","timestamp":1787676278276,"version":"build-2784847793"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T00:00:00Z","timestamp":1633824000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p>Hepatitis C virus (HCV) prevalence is high among people experiencing homelessness, but barriers to scaling up HCV testing and treatment persist. We aimed to implement onsite HCV testing and education and evaluate the effectiveness of low\u2010barrier linkage to HCV therapy among individuals accessing homeless shelters. HCV rapid testing was performed at four large shelters in San Francisco (SF) and Minneapolis (MN). Sociodemographic status, HCV risk, barriers to testing, and interest in therapy were captured. Participants received information about HCV. Those testing positive underwent formal HCV education and onsite therapy. Multivariable modeling assessed predictors of receipt of HCV therapy and sustained virologic response (SVR). A total of 766 clients were tested. Median age was 53.7\u00a0years, 68.2% were male participants, 46.3% were Black, 27.5% were White, 13.2% were Hispanic, and 57.7% had high school education or less; 162 (21.1%) were HCV antibody positive, 107 (66.0%) had detectable HCV RNA (82.1% with active drug use, 53.8% history of psychiatric illness), 66 (61.7%) received HCV therapy, and 81.8% achieved SVR. On multivariate analysis, shelter location (MN vs. SF, odds ratio [OR], 0.3; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.01) and having a health care provider (OR, 4.1; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.02) were associated with receipt of therapy. On intention to treat analysis, the only predictor of SVR when adjusted for age, sex, and race was HCV medication adherence (OR, 14.5; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.01). <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Leveraging existing homeless shelter infrastructure was successful in enhancing HCV testing and treatment uptake. Despite high rates of active substance use, psychiatric illness, and suboptimal adherence, over 80% achieved HCV cure. This highlights the critical importance of integrated models in HCV elimination efforts in people experiencing homelessness that can be applied to other shelter settings.<\/jats:p>","DOI":"10.1002\/hep4.1791","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T18:27:32Z","timestamp":1633890452000},"page":"50-64","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":21,"title":["Shelter\u2010Based Integrated Model Is Effective in Scaling Up Hepatitis C Testing and Treatment in Persons Experiencing Homelessness"],"prefix":"10.1097","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9178-9139","authenticated-orcid":false,"given":"Mandana","family":"Khalili","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Department of Medicine,University of California San Francisco,San Francisco,CA,USA"},{"name":"Division of Gastroenterology and Hepatology,Department of Medicine,Zuckerberg San Francisco General Hospital,San Francisco,CA,USA"},{"name":"University of California San Francisco Liver Center,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Powell","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare,Minneapolis,MN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1006-7028","authenticated-orcid":false,"given":"Helen H.","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Department of Medicine,University of California San Francisco,San Francisco,CA,USA"},{"name":"Division of Gastroenterology and Hepatology,Department of Medicine,Zuckerberg San Francisco General Hospital,San Francisco,CA,USA"},{"name":"School of Medicine,University of California San Diego,La Jolla,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dylan","family":"Bush","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Department of Medicine,University of California San Francisco,San Francisco,CA,USA"},{"name":"Division of Gastroenterology and Hepatology,Department of Medicine,Zuckerberg San Francisco General Hospital,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Naugle","sequence":"additional","affiliation":[{"name":"San Francisco Department of Public Health,Street Medicine and Shelter Health,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Ricco","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare,Minneapolis,MN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Magee","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Department of Medicine,Zuckerberg San Francisco General Hospital,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace","family":"Braimoh","sequence":"additional","affiliation":[{"name":"Hennepin Healthcare,Minneapolis,MN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Zevin","sequence":"additional","affiliation":[{"name":"San Francisco Department of Public Health,Street Medicine and Shelter Health,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4299-689X","authenticated-orcid":false,"given":"J. 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