Theme: Models of Care Year: 2024
Background: CUPS is a multi-disciplinary clinic in Calgary, Canada that provides health and wrap-around social services to people experiencing poverty and homelessness. Despite operating within a setting which prioritizes care for the most structurally vulnerable groups, our HCV pathway can be best described as “simple but not easy”. Significant systemic factors limit equitable access to HCV treatment, including rising opioid use and homelessness, a lack of primary and mental healthcare, and difficulties accessing income support and medical benefits.
Description: Traditional care cascades present HCV care as linear, however, frontline providers intimately understand that the path to cure is often circuitous. To acknowledge these systemic and socioeconomic realities, we are reorienting our clinical data collection to capture relevant aspects of care that lie beyond the traditional HCV care cascade.
Effectiveness: Between July 2022 – February 2024, we received 272 HCV treatment referrals; 51% (140/272) of people were experiencing homelessness or unstable housing, while 20% (56/272) were uninsured for HCV medications. The average number of days between the prescription being written and starting HCV treatment was 90 days, with 14% (39/272) of clients waiting >90 days. We are now collecting additional data on whether people’s foundational needs (including primary care access, and support with housing, income and mental health) are being met prior to treatment engagement and how this impacts the HCV care cascade.
Conclusion: We have reoriented our clinic data analysis to better reflect the realities of the barriers we see “beyond the care cascade”, particularly for the most severely underserved populations. This will support better HCV care and can be used to inform advocacy and policy change. Hopefully, this will stimulate a larger conversation about why social needs are going unaddressed and ultimately landing primarily on a healthcare system that was not designed to address the social determinants of health.
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