From the Valley Homeless Healthcare Program (CJH, CP, KF, SLD, LK), Department of Medicine, Division of Primary Care, Santa Clara Valley Medical Center, San Jose, CA; Division of Gastroenterology, Santa Clara Valley Medical Center (AK, RJK), San Jose, CA; Stanford University School of Medicine (CJH, SLD, RJK, AK), Stanford, CA.
Individuals with psychiatric disease, substance abuse, and/or housing instability have a high prevalence of chronic hepatitis C virus (HCV) infection. However, such individuals are often excluded from treatment for HCV infection because of a perceived inability to adhere to the rigorous medication regimen required.
A pilot program using a multidisciplinary group medical visit model to treat HCV infection in the aforementioned population was created. Medication adherence and virologic response rates were prospectively followed.
Approximately 80% of patients were adherent to their HCV infection treatment regimen, as measured by attendance at group medical visits and by medication adherence. A sustained virologic response rate of 55% among individuals with genotype 1 infection and 80% among individuals with genotype 2 or 3 infections was observed. These results compare favorably with those seen in large, randomized controlled trials. Rates of discontinuation and adverse effects were similar to those seen in other studies.
An intensive, multidisciplinary treatment approach toward HCV infection treatment can achieve favorable results even in persons traditionally considered to be "poor treatment candidates." Programs aimed at bringing HCV infection treatment to this population are needed.