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Homeless programs

 
Health Care for the Homeless, Baltimore, MD
Program name: Health Care for the Homeless, Baltimore, MD
Population served: The homeless
Eligibility: Homeless clients presenting at our clinic or contacted through outreach
Region served: Baltimore, MD
Funding: Federal
Program started: The community health clinic began serving clients in1985; this specific hepatitis initiative began in 1997
Number of clients: 5,300/year
Contact: Njide Udochi, MD, MPH
Medical Director
Health Care for the Homeless
111 Park Avenue
Baltimore, MD 21201
Phone: (410) 837-5533
Fax: (410) 837-8020
Email: nudochi@hchmd.org
Website: None
Description:

Health Care for the Homeless (HCH) serves 5,300 clients a year in Baltimore; 3,200 at the HCH clinic and 2,100 more in outreach. Basic demographics: 96% are homeless, 69% are men, 82% are African-American, 18% have a history of mental illness, 4% are HIV positive, and 18% report illicit drug use. Because hepatitis C is particularly severe among clients with HIV and/or alcohol abuse, we began screening for hepatitis C in 1997.

We were interested in risk factors for clients testing positive for hepatitis C, and especially what percentage of them would be eligible for vaccination against hepatitis B and A. We conducted a study from January 1, 1997-June 30, 2000, testing HCH clinic clients for hepatitis C infection. We collected basic demographic data and information on behavioral risk factors, such as unprotected heterosexual sex, men having sex with men, injection drug use, non-injection drug use, and alcohol use.

During this time period, we had 397 clients test positive for hepatitis C. Out of these, 274 were eligible for hepatitis B immunization and approximately 313 were eligible for hepatitis A immunization.

We then compared these 397 hepatitis C positive clients (cases) with 2,535 hepatitis C negative clients (controls). These cases and controls were very similar in terms of their basic demographics. We looked at the hepatitis C clients’ risk factors and co-morbidities compared to the controls, and got the following results:

Risk factor/co-morbidity

Odds ratio

95% confidence interval

Heterosexual sex (unprotected)

2.1

1.7-2.8

MSM

1.8

1.2-2.6

Illicit drug use

3.2

2.5-4.0

HIV/AIDS

2.8

1.9-4.0

Alcohol abuse

2.3

1.8-2.8

Hepatitis B

21.9

15.4-31.0

Conclusions:

  1. Hepatitis C positive homeless clients are at higher risk for the transmission of hepatitis B than hepatitis C negative homeless clients.
  2. 70% of hepatitis C positive clients are eligible for hepatitis A and hepatitis B immunization.
  3. Hepatitis C clients are seen frequently enough at HCH to complete a 2 or 3-shot vaccine series (the hepatitis C positive clients surveyed had an average of 17 visits each to the clinic during the 3˝ year period of this study).

We have applied to several grantors for funding to support our immunization program and recently received $10,000 to purchase vaccine. We will begin providing vaccination against hepatitis A and B for hepatitis C positive clients, using Twinrix, in December 2001. To assist in tracking clients in our Hepatitis Immunization Program we will be using VacTrac, a vaccination tracking computer program.


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