A smartphone application and ultrasound machine are all it takes for Josie Ruíz to evaluate a hepatitis C patient's liver. The health care worker at La Maestra Community Health Centers in San Diego's City Heights neighborhood uses a FibroScan to measure the internal organ and then punches the figures into her mobile phone to determine if the infection has caused tissue damage or fibrosis.
The scan is one of the easier steps treating hepatitis C patients — La Maestra officials say the weeks-long medication for the disease has a high success rate — while the bigger challenge is getting the most vulnerable patients into care.
A new report from San Diego County Health and Human Services Agency shows hepatitis C is prevalent among people experiencing homelessness. Yet health care providers face hurdles connecting those patients with treatment but are developing a plan to address the barriers and establish prevention strategies.
San Diego experienced an outbreak of hepatitis A a few years ago that killed 20 people, most of them homeless, but that virus is vaccine-preventable while hepatitis C is not. The county health department's monthly communicable disease report released last week identified 247 cases of infectious diseases involving homeless patients last year and 53% had chronic hepatitis C. The county only recently began tracking housing status for the communicable disease cases it investigates.
La Maestra’s Dr. Adla Tessier said the nonprofit has a mobile clinic to bring care directly to the homeless population and asses their hepatitis C risk, but that's only the first step.
"We do a one-time screening for those patients and whenever they’re screened, we need to confirm whether they’ve just been exposed or are actually carrying the disease," Tessier said.
While about 20% of people can fight off the infection, she said, it becomes a chronic condition for the majority who contract it. But that confirmation requires a visit to a physical location for a blood test and not every patient follows through.
A La Maestra spokeswoman said the nonprofit last year provided care to 3,535 homeless individuals, but only about 12% were tested for hepatitis C — 73 were positive — even though the clinic will provide patients with transportation.
La Maestra is not alone, and is among a coalition of health care providers, including other nonprofits, in the region working to address barriers like these. Family Health Centers of San Diego is leading the group to develop a hepatitis C elimination plan that will go to the San Diego County Board of Supervisors next month.
Dr. Christian Ramers, an assistant medical director at Family Health Centers who is spearheading the effort, said the upcoming presentation will just be an outline but he hopes it'll get supervisors' support and lead to a fully fleshed-out strategy with funding attached.
"The county has as of yet very limited resources dedicated to hepatitis C surveillance and testing and treatment, and so yes, part of the ultimate goal would be to collaborate between public and private sources in order to make this elimination a reality," he said.
Tessier at La Maestra said progress can be made if vulnerable patients like those without shelter are linked into care.
"Convincing them that this treatment, that there’s a very high success rate for treatment and very minimal side effects," she said.
To improve its care for homeless patients who have been confirmed with hepatitis C, La Meastra is working to add an ultrasound machine, or FibroScan, to its mobile unit. Right now, it's only available at its brick-and-mortar facility. But it still has to address the barrier of getting them into treatment in the first place.
The elimination plan coming before the board in March will not only look at those hurdles but how to prevent transmission in the first place.
