15 April 2025
Our latest Hepatitis C Elimination Community of Practice webinar brought together more than 100 participants to explore the delivery of street-based medicine programs for hepatitis C care delivery. Focused on models that meet people where they are at—both physically and mentally—the session profiled three innovative programs in the United States that show how person-centred street-medicine models can build trust between providers and patients.
Street medicine isn’t just about delivering care outside the clinic. It’s about creating systems that work for people who’ve been excluded from traditional healthcare. That includes (but is not limited to) people living in tents, parks, under bridges, in cars, or on the move. Hepatitis C care in this context isn’t a standalone project—it’s built into long-term, relationship-first medical support that prioritises continuity, dignity, and access.
If you missed the live event, you can catch up on the webinar in the video below or read on to discover key takeaways from each of our three speakers.
USC Street Medicine – Brett Feldman
“The worst poverty we see is not material—it’s the spiritual poverty of feeling unwanted. Street medicine is our answer to that.”
Operating in Los Angeles, USC Street Medicine is one of the longest-running programs of its kind in the US. The team is grounded in the principle that health care should not be something people have to fight for or feel unwelcome receiving. It’s taken to them—on foot, by people they trust.
Key features:
- Six full-time teams comprised of a prescriber, nurse, and community health workers
- 24% hepatitis C positivity rate, with an 82% treatment completion rate
- Broad service scope including psychiatry, HIV care, substance use disorder treatment, and wound care
- Hepatitis C treatment embedded within general care—no separate team or referrals
- EMR systems support consistent follow-up and hospital integration
What makes this model stand out is its long-term engagement. If a patient moves into housing, the team follows. If they’re relocated, the team goes to them. Hepatitis C care is part of an ongoing relationship, not a one-off intervention. The results speak for themselves: emergency visits down 80%, hospitalisations and readmissions down nearly 75%.
Clinic of Sierra Vista, Bakersfield – Dr Matt Beare
“What’s going to make any one team impactful is the relationships you build. Do what you say you’re going to do. If you tell a patient, ‘Hey, I’m going to get you those socks…’ do that a hundred percent of the time.”
Set in the harsh environment of central California, the Bakersfield-based team delivers street medicine in some of the most challenging conditions in the country—sweltering summers, high rates of illiteracy, and deep poverty. Their approach is hands-on, flexible, and centred around going wherever people are, whether that’s by a riverbank or inside a cave.
Key features:
- Five mobile teams servicing remote and urban areas across Bakersfield and Lake Isabella
- Veterinary care included—patients often prioritise their animals over themselves
- Onsite wound care, harm reduction, HCV screening, and mental health support
- Now able to draw blood in the field, allowing for more rapid HCV treatment starts
- Services often delivered in extreme conditions with limited infrastructure
This program sees a significant number of patients with pets. Dogs, rats, snakes—even a possum or two. Understanding the bond between people and their animals, the team integrated veterinary support into their rounds. That trust has opened the door to deeper engagement and more consistent care. They’re now expanding their ability to treat hepatitis C onsite, without needing to refer patients elsewhere.
NYC Health + Hospitals, South Bronx – Dr Ben Eckhart
“We don’t compartmentalise it. Hep C care, substance use treatment, diabetes, high blood pressure. It’s all under one roof.”
This mobile unit, part of the NYC Health + Hospitals public health system, operates out of the South Bronx—one of the city’s most affected areas for both homelessness and hepatitis C. The van is a base, but most care happens on foot. The team visits known homeless emcampments, injection sites, shelters, safe havens, and soup kitchens, offering comprehensive care on the spot.
Key features:
- One of six mobile units citywide, with a focus on providing comprehensive care (primary care, substance use disorder, infectious diseases, etc.) to homeless and marginally housed individuals. ID, primary care, and substance use disorder
- Strong partnerships with local Syringe Service Programs, methadone clinics, shelters, and hospitals
- EMR-powered registry flags untreated HCV cases for proactive outreach
- Lab-based testing model allows time to build trust before starting treatment
- Medication delivery and dispensing adjusted to patient preference and stability
This team chose not to use point-of-care RNA tests. Instead, they focus on building the relationship first—treating wounds, managing infections, starting conversations. When patients are ready for hepatitis C treatment, the team already knows them, already has the lab work, and already has a plan. It’s a slower path—but one that builds lasting engagement and treats the whole person, not just their virus.
Shared themes across all programs
- Access must come first—if people can’t reach the service, it’s not working
- Trust is built over time, through consistency, respect, and presence
- Teams need to be agile and responsive, not constrained by clinic hours or red tape
- Integration with the health system (Electronic Medical Records, pharmacies, labs) helps bridge the gap
The strongest advice from speakers: don’t overplan. Start with what you have. That might be one nurse, a doctor friend, and a backpack. It’s enough to begin. The most important ingredients are trust, consistency, and showing up. Whether or not you have a van or budget, the work starts by building relationships.
