Multiple Barriers Prevent Better HCV Care for Homeless Population


The rigidity of hospital settings and a lack of awareness prevents better hepatitis C virus diagnoses in the homeless population.

Martha Paisi, PhD

Martha Paisi, PhD

There are a number of reasons why individuals with lived homeless experiences are unable to receive hepatitis C virus (HCV) screenings and treatments.

A team, led by Martha Paisi, PhD, Senior Research Fellow, Research Lead, School of Nursing and Midwifery, University of Plymouth, identified and described the barriers and facilitators for screening and treating HCV for adults with lived experience of homelessness in highly developed countries.


Individuals who have been homeless at 1 point in time are often at an increased risk of HCV infections than the general population. With access to HCV care and screenings limited in this population, treatment uptake is notoriously low.

In the study, the research combed various databases for studies and identified 12 papers or reports in the final analysis. There several interacting factors shown to influence access to HCV testing and case for the patient population, some of which mirror the general population.

Of the final 12 studies, 9 were qualitative and 3 were quantitative, 1 of which was a randomized controlled trial. In addition, 6 studies took place in the US, 5 studies took place in the UK, and 1 study took place in Ireland. The studies were also conducted in a variety of different settings or contexts, including clinics within a program of healthcare for people experiencing homelessness (n = 1), homeless shelters (n = 3), research cohorts (n = 4), and outreach hepatitis C testing and intervention (n = 1).

Other settings included outreach services for drug use and homelessness offering point of care HCV, hepatitis B virus and HIV testing (n = 1); an outreach HCV treatment clinic established within a primary care facility (n = 1), and a community-based partnership offering HCV treatment and support to people who inject drugs in a drug and alcohol support program with a community-based HCV outreach service (n = 1).

The research team included a peer advocate, a hepatology nurse, and a community volunteer. Each member has significant experience promoting and engaging in HCV care and outreach with individuals experiencing homelessness.

Barriers to Care

Overall, the conditions related to homelessness and the rigidity of the hospital settings, as well as a lack of awareness were deemed the dominant barriers.

Other factors included flexibility, outreach, effective communication, tailoring and integration of services.

In addition, there is not much evidence found involving a minority population.

“People experiencing homelessness face multiple barriers in accessing and completing HCV treatment, relating to both their lived experience and characteristics of health systems,” the authors wrote. “Although some barriers are readily amenable to change, others are more difficult to modify.”

The study results could influence policy decisions moving forward.

“The facilitators identified could inform future targeted measures to improve HCV diagnosis and treatment for people experiencing homelessness,” the authors wrote. “Research is warranted into successful models to promote screening, diagnosis and treatment.”

In 2015 there was an estimated 71 million individuals with a chronic HCV infection worldwide. One of the main causes of infection is intravenous drug use, which is also highly prevalent among the homeless community.

The study, “Barriers and facilitators to hepatitis C screening and treatment for people with lived experience of homelessness: A mixed-methods systematic review,” was published online in Health Expectations.

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