Peer-Delivered Outreach With Rapid Treatment Pathways for Hepatitis C Testing and Treatment Among Unhoused People

This service evaluation describes the co-development of a peer-led rapid hepatitis C virus (HCV) pathway to reach unhoused people. A trained and qualified peer worker visited homeless shelters in West Midlands, England, setting up test and treatment events and collaborating with local services and healthcare staff who also attended the sites. The peer worker offered point of care HCV antibody and ribonucleic acid (RNA) testing for individuals at risk of HCV, peer education and support before and during treatment. Viraemic individuals were offered immediate treatment prescribed by local HCV clinical specialist nurses who attended the homeless shelters with the peer worker. Among the 140 tested individuals, 72 people (51.4%) were HCV antibody positive and 42 (30.0%) were HCV RNA positive. All participants had a history of injecting drug use. The majority were male (75.0%), with a mean age of 39 years and of white ethnicity (89.4%). Treatment uptake was 100.0%, and known treatment completion was 92.3%. Treatment uptake within 2 weeks was 57.1%. Findings suggest that the co-developed and peer-led HCV test and treat pathway is promising in case finding, testing and treating marginalised, unhoused people.