# Development of a Community-based HCV Treatment Completion Intervention Among HCV Positive Homeless Adults

> **NIH NIH R21** · UNIVERSITY OF CALIFORNIA-IRVINE · 2020 · $277,472

## Abstract

ABSTRACT
Hepatitis C Virus (HCV) infection, the most common chronic blood-borne viral infection in the US, disproportionately
affects homeless and drug-using populations, creating a significant health disparity and representing a critical focus for
effective prevention at the individual and community level. Compared to the general population, homeless persons have
a 26-fold increase in HCV prevalence, a diagnosis strongly associated with injection drug use (IDU). Focused screening,
early detection and treatment for homeless adults are critical for effective treatment. Yet while interferon-based HCV
treatment protocols have shown efficacy in 60% of patients, many do not continue treatment as a result of severe side-
effects. Further, only 1-6% of illicit drug-using HCV-infected persons receive any treatment, despite current treatment
guidelines. Successful treatment for HCV with direct acting antiviral (DAA) drug regimens may provide an alternative
solution, targeting specific steps along the HCV lifecycle. These treatments have not been assessed among homeless
adults. Factors associated with low adherence to hepatitis treatment among homeless adults include untreated mental
illness, ongoing drug and alcohol use, unstable housing, and limited access to care. To address these disparities, we will
pilot test a theoretically-based innovative model of care, successfully implemented by our team in other vulnerable
populations, among HCV-infected homeless persons. Utilizing a community-based delivery approach, a community
health worker (CHW), guided by a registered nurse (RN), will deliver a CHW/RN program, with HCV medication
treatment delivered using directly observed therapy (DOT) to eligible HCV-infected homeless adults. For the first time,
using a community-based approach, our CHW/RN team will implement the intervention program which includes
administration of DAA in the community where the participant lives, rather than a health care facility. In Phase I, using
community participatory approaches, we plan to develop and refine the culturally-sensitive intervention program,
focusing on reducing health disparities. Acceptability and feasibility will be rigorously evaluated. In Phase 2, we will
assess the impact of the CHW/RN intervention among 108 eligible HCV-infected homeless adults in Los Angeles,
primarily on HCV treatment completion, and cure, and secondarily on mental health, substance use, access to care and
shelter stability, as compared with a primary care clinic-based standard of care (cbSOC) model. Individual-level factors
that are potential mechanisms that underlie health disparities in completing HCV treatment (e.g., social support, stable
housing, mental illness) will be evaluated. We hypothesize that our CHW/RN-based model will be superior to the cbSOC
program at improving HCV treatment completion, preventing progression of HCV disease, and improving secondary
outcomes (e.g., mental health, access to care, etc). By extension, our inter...

## Key facts

- **NIH application ID:** 10022164
- **Project number:** 5R21MD013580-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA-IRVINE
- **Principal Investigator:** Lillian Gelberg
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $277,472
- **Award type:** 5
- **Project period:** 2019-09-20 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10022164

## Citation

> US National Institutes of Health, RePORTER application 10022164, Development of a Community-based HCV Treatment Completion Intervention Among HCV Positive Homeless Adults (5R21MD013580-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10022164. Licensed CC0.

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