1. Treat first! Shade says…
Establishing Access to Hepatitis C Treatment in a Nurse Practitioner-led Community-Based Syringe Access Center in San Francisco
Pauli Gray
(He/Him/His)
Sr SAS HCV Wellness Coordinator
Pierre-Cédric Crouch, PhD, ANP-BC, ACRN
Director of Nursing

2. Disclosures We have no disclosures
San Francisco and California have privilege which makes this work easier than other places
San Francisco AIDS Foudation

3. 1 2 Objectives Why we do this Walk through Hep C Health Program
San Francisco AIDS Foudation

4. TREAT FIRST! 5 PRONGS: TREAT at Syringe Access sites
SHADE SAYS...
TREAT FIRST!
5 PRONGS:
TREAT at Syringe Access sites
NO HOOPS to jump through
OFFER HCV MED STORAGE
SUPPORT/WRAP-AROUND SERVICES
SECONDARY GOALS

5. TAKEAWAYS
Each time we partner to cure a single case of PWID Hep C, we are helping prevent 25 others from being infected
We have the unique opportunity of curing the deadliest communicable disease and the honor of facilitating a huge change and providing hope in people’s lives.

6. San Francisco AIDS Foundation
Harm Reduction Center
Mobile Testing Unit
Magnet at Strut
Main Downtown Office
SAN FRANCISCO AIDS FOUNDATION

7. Hepatitis C Program End Hep C SF Hep C Treatment Priority Communities
Out of care
Expanded Magnet
HCV Testing
Priority Communities
IDU, Gay/MSM, Kink/Blood, HIV Positive
Hep C Navigation and Treatment Support
Tx Breakfast
Medication Storage
End Hep C SF
San Francisco AIDS Foundation

8. Harm Reduction Center Visit Schedule
Screening
H&P:
Focus on Cirrhosis
Labs:
CBC, LFTs, PT- INR, HCV RNA, HCV GT
HCV Counseling
Prior Authorization
Initiation
Within 1-2 weeks of screening
Adherence Counseling
Week 4
HCV Counseling
CBC, LFTs, HCV RNA
Week 8, 12
HCV Reinfection Counseling
SVR12
HCV Reinfection Counseling
Labs: HCV RNA
Ongoing treatment breakfast, medication storage, & HCV counseling by navigators
San Francisco AIDS Foundation

9. Hep C Treatment Program Eligibility
Generally Healthy over age 18
Exclude decompensated cirrhosis
Prefer monoinfected Hep C
May work with HIV coinfected with PCP
Do not bill professional fees
Allows us to accept most insurance for labs and meds
No need to change medical home
Unable to treat Kaiser or VA clients
Able to treat uninsured and undocumented clients
Abbvie and Gilead Patient Assistance
San Francisco AIDS Foundation

10. Outcomes Age 26-69 (43.8) Gender Cis-male 34 Cis-female 8 Transfemme 1
Clients Screened 86
Clients Initiating treatment 61
Clients Completing Treatment 44
(14 active)
Clients Achieving SVR12
21/23 (91%)
Clients not initiating
6-Cleared Hep C
2-Medically complex
1-Enrolled in Research
3-Did not return to initiate
3-other
Clients with Incomplete Treatment 3
Clients Not Achieving SVR12
1 Reinfected
1 Adherence
Cross-sectional data from
November 9, 2018
San Francisco AIDS Foundation
Table 1
Demographics
Age
26-69 (43.8)
Gender
Cis-male 34
Cis-female 8
Transfemme 1
Transmasculine
Gender Non-conforming 2
Race/Ethnicity
Latinx
White 30
AA/Black 9
Asian/API
Multiple 4
Table 1
Demographics
Age
26-69 (43.8)
Gender
Cis-male 34
Cis-female 8
Transfemme 1
Transmasculine
Gender Non-conforming 2
Race/Ethnicity
Latinx
White 30
AA/Black 9
Asian/API
Multiple 4

11. Demographics Age Range Mean 26-69 (43.8) Gender Cis-male 34 (76%)
24-69 (42.3)
Gender
Cis-male
67 (78%)
Cis-female
15 (17%)
Transfemme
1 (1%)
Transmasculine
0 (0%)
Gender Non-Conforming
2 (2%)
Race/Ethnicity
Latinx/o/a
6 (7%)
White
58 (67%)
AA/Black
17 (20%)
Asian/PI
Native American
Multiple
3 (4%)
Table 1
Demographics
Age Range
Mean
26-69 (43.8)
Gender
Cis-male
34 (76%)
Cis-female
8 (18%)
Transfemme
1 (2%)
Transmasculine
0 (0%)
Gender Non-conforming
2 (4%)
Race/Ethnicity
Latinx
White
30 (68%)
AA/Black
9 (20%)
Asian/API
Native American
Multiple
4 (9%)
Table 1
Demographics
Age Range
Mean
26-69 (43.8)
Gender
Cis-male
34 (76%)
Cis-female
8 (18%)
Transfemme
1 (2%)
Transmasculine
0 (0%)
Gender Non-conforming
2 (4%)
Race/Ethnicity
Latinx
White
30 (68%)
AA/Black
9 (20%)
Asian/API
Native American
Multiple
4 (9%)
Table 1
Demographics
Age Range
Mean
26-69 (43.8)
Gender
Cis-male
34 (76%)
Cis-female
8 (18%)
Transfemme
1 (2%)
Transmasculine
0 (0%)
Gender Non-conforming
2 (4%)
Race/Ethnicity
Latinx
White
30 (68%)
AA/Black
9 (20%)
Asian/API
Native American
Multiple
4 (9%)
San Francisco AIDS Foundation

12. Demographics Primary Care Provider Barrier No provider in last year
58 (67%)
Provider with Cultural Barrier (problem with their provider)
10 (12%)
Clinic with Structural Barrier
(problem with how clinic is set up)
5 (6%)
Prefer treatment at SFAF despite easy access elsewhere
13 (15%)
Housing
Marginally housed (SRO)
11 (13%)
Homeless
44 (51%)
Stable Housing
31 (36%)
Substance Use
Current Use
77 (90%)
Prior Use
6 (7%)
Never used
3 (4%)
San Francisco AIDS Foundation

13. Demographics AST to Platelet Ratio >1 (potential liver damage)
14 (18%)
<1 (less likely to have liver damage)
62 (82%)
Weeks of Treatment
8 weeks
58 (78%)
12 weeks
15 (22%)
San Francisco AIDS Foundation

14. Discussion
People living with active substance use can successfully be cured of Hepatitis C.
Differentiated Service Delivery of Hepatitis C treatment in a Syringe Access Service can reach communities who traditional healthcare settings have struggled to reach.
San Francisco AIDS Foundation

15. Facilitators Facilitators
A ”treat first” approach allows for clients to focus on Hepatitis C treatment
Newer 8 week treatments facilitate cures
Expanded Nursing Scopes of Practice
No billing of professional fees
Reduced barriers for Medi-Cal/Medicaid coverage
San Francisco AIDS Foundation

16. Barriers Barriers Lack of Nurse Practitioner Autonomy in California
Blood Specimen Collection
Microtainers, Newer technologies use capillary sticks
Funding to expand program
San Francisco AIDS Foundation

17. Thank You! To all the clients who put their trust in our team.
All SFAF staff and volunteers and the San Francisco community who support our work.
Protocols:
San Francisco AIDS Foundation

18. TREAT FIRST, SAVE LIVES SPREAD THE WORD

19. Contact Info
Pauli Gray
Pierre-Cedric Crouch
Janessa Broussard
San Francisco AIDS Foundation