GRASSROOTS HEALTH

Hepatocellular carcinoma, or liver cancer, is the fastest growing cancer in the United States, with a large portion of its cases due to chronic infections of viral hepatitis B or C (HBV; HCV).¹ Liver cancer is highly fatal, but prevention is possible with HBV and HCV risk reduction, including HBV vaccination and antiviral treatments.² 

Additionally, individuals with experiences of homelessness (IEH) are much more likely to contract viral hepatitis than members of the general population, with some studies finding prevalence rates as high as 47-86%.^3,4 Individuals with experiences of homelessness are also historically disproportionately impacted by HBV/HCV- throughout the hepatitis continuum of care, meaning while being burdened with a high prevalence of these diseases, they are unable to effectively receive testing, vaccination, or treatment.⁵  

The movement towards a permanent supportive housing (PSH) model provides a new opportunity to engage IEH, and the point at which GRASSROOTS HEALTH hopes to engage IEH.  

GRASSROOTS HEALTH is a cross-sector collaboration between a healthcare for the homeless clinic, academic institution, and permanent supportive housing (PSH) provider. 

Our Main Goal: To enhance health equity by bringing HBV/HCV education, testing, HBV vaccination and HBV/HCV treatment directly to the door of PSH residents. 

References 

1. Cronin, K.A., Lake, A.J., Scott, S., Sherman, R.L., Noone, A.-M., Howlader, N., Henley, S.J., Anderson, R.N., Firth, A.U., Ma, J., Kohler, B.A. and Jemal, A. (2018), Annual Report to the Nation on the Status of Cancer, part I: National cancer statistics. Cancer, 124: 2785-2800. https://doi.org/10.1002/cncr.31551
2. Villanueva A. (2015). Acute-on-chronic liver failure: pathophysiology, prognostication, and treatment. Hepatology, 62:165-174. 
3. Hofmeister, Megan G.1,2; Rosenthal, Elizabeth M.3; Barker, Laurie K.1; Rosenberg, Eli S.3; Barranco, Meredith A.3; Hall, Eric W.4; Edlin, Brian R.5; Mermin, Jonathan5; Ward, John W.1,6; Ryerson, A. Blythe1. Estimating Prevalence of Hepatitis C Virus Infection in the United States, 2013?2016. Hepatology 69(3):p 1020-1031, March 2019. | DOI: 10.1002/hep.30297
4. Page, K., Yu, M., Cohen, J. et al. HCV screening in a cohort of HIV infected and uninfected homeless and marginally housed women in San Francisco, California. BMC Public Health 17, 171 (2017). https://doi.org/10.1186/s12889-017-4102-5
5. Stein, J. A., Andersen, R. M., Robertson, M., & Gelberg, L. (2012). Impact of hepatitis B and C infection on health services utilization in homeless adults: A test of the Gelberg-Andersen behavioral model for vulnerable populations. Health Psychology, 31(1), 20–30.

Thank you to CPRIT for generously funding this work. Grant ID: PP220022. Liver Cancer Prevention Among Those with Experiences of Homelessness: An Expansion to Low-Income Housing in South Texas. PI: Vanessa Schick, PhD (Houston); Jack Tsai, PhD (San Antonio)