In July 2020, when many medical centers were slashing non-COVID-19 testing, Meghan Morris, an associate professor of epidemiology at the University of California, San Francisco, and her colleagues rented a storefront in San Francisco’s South Market neighborhood and instead resorted to did the opposite.
Over the next 15 months, they conducted a study that tested nearly 500 people for hepatitis C, a potentially fatal but treatable viral infection that can lead to cirrhosis or liver failure. Of the 89 patients diagnosed, 98% started taking powerful new drugs that can cure the disease, a much higher rate than the proportion of hepatitis C patients in the general population who start treatment after diagnosis.
The findings, set to be published Friday in the journal JAMA Online Open, suggest that testing and treatment for hepatitis C — where new cases have been increasing nationwide for nearly a decade — can be done safely and effectively outside of traditional medical offices. .
In the study, participants went to a pop-up store to get an antibody test and then had their blood drawn to confirm the diagnosis; if they wanted to start taking the medication, once the test results were confirmed, they were sent home to begin a 12-week treatment regimen.
The cost of the medication for the first two weeks was paid for by the study’s sponsor. After that, participants’ health insurance companies or public plans typically cover the cost of the drug, which is made by Gilead Sciences and is called sofosbuvir/velpatasvir, or Epclusa. Overall, 79% of trial participants who were diagnosed and treated with the drug completed the 12-week course of treatment.
The researchers say their findings could open the door to bringing this direct service model to shelters, libraries, transportation hubs and other community venues to reach those who need it most: people who inject drugs and the homeless . The vast majority (approximately 80%) of Americans with hepatitis C contracted the disease through injection drug use.
About 80 percent of Americans with hepatitis C contracted the disease through injection drug use.
Gabriel Lurie/ChronicleThe hepatitis C drugs that have come out in the past decade are a significant improvement over previous iterations, which were more like a cancer treatment that took nearly a year to complete and had to be given in a specialist clinic. Newer hepatitis C drugs are antivirals taken daily for 8 or 12 weeks that are cheaper, more readily available, and very effective, with cure rates of 90 to 95 percent. But health care providers have struggled to get high-risk patients to take the drugs.
Overall, Morris said, more people are getting tested for and receiving treatment for hepatitis C today. But those with the greatest burden of hepatitis C — Black Americans, people who inject drugs and the homeless — haven’t seen the same increase in the number of people seeking treatment.
The study originally planned a second site, a mobile van, in Bayview-Hunters Point, but it was too small to meet social distancing requirements at the time. Attempts to set up the tent outdoors failed due to unexpected weather and wildfire season, so researchers moved all operations to the SOMA site.
“We created this model because we wanted to think about how to get them to where they are,” Morris said. “Let’s stop trying to engage them in the health care system and instead build bridges to the health care system for them.”
Contact Katherine Ho: cho@sfchronicle.com