PS 1-26
PATIENT EMPOWERMENT IN HEALTH CARE ENGAGEMENT: A FOCUS ON VULNERABLE POPULATIONS
Of the 18,000 residents of Vancouver’s Downtown East Side (DTES), over 70% are infected with HCV. To date, less than 5% have received curative HCV therapy - with only a minority engaged in health care that could lead to this outcome. The purpose of this study is to evaluate the effectiveness of community pop-up clinics (CPCs) as a tool to diagnose Hepatitis C (HCV) in this population and to subsequently engage infected men and women in a multidisciplinary care model of health care delivery, with an ultimate goal of providing HCV treatment to all those in whom it is medically indicated.
Method:
CPCs are held at various DTES sites - drop-in centres, homeless shelters, soup kitchens, and supervised injection facilities. Individuals interested in point-of-care testing for Hepatitis C are registered and an explanation of how the OraQuick® HCV Rapid Antibody tests work is provided. For their participation in testing, a $10 gift card is provided as an incentive. Individuals testing positive for HCV antibodies are offered immediate medical consultation on-site and a follow-up appointment at our center to address their medical, psychological, social, and addiction-related needs. A questionnaire was also administered to collect demographic, clinical, and knowledge-based information.
Result:
Since March 2013, a total of 2003 participants (mean age 49.9 years, 93.4% male) have been tested for HCV infection, with 641 (32%) having a positive test result, 49 (7.6%) co-infected with HIV. Among HCV infected participants, 154 (24.2%) were linked to care (76% male, 30% First Nations, 28% homeless, 78% recent injection drug users). Groups under-represented among those engaged in care include: females (7% of the engaged population), those who lack knowledge about how to access health care (9%), those without stable housing (9%), those who perceived their health status as good (14%), and men and women identifying as First Nations (15%).
Conclusion:
The CPC model applied to Vancouver’s Downtown East Side has successfully identified over 600 HCV-infected individuals and engaged a significant percentage of them in care. Additional strategies must be developed to better engage those who do not yet seem to have followed up as a result of the initial outreach strategies attempted to date.