More than 1,000 people who had previously been sleeping rough were tested for blood-borne viruses between May and August this year, according to a new report from the London Joint Working Group on Substance Use and Hepatitis C (LJWG).
Of those who were tested for hepatitis C, more than one in ten were found to have antibodies for the virus, with 7 per cent identified as having an active infection. 
The report details the efficient joint working between healthcare teams, peer workers and hotel staff during the ‘Everyone In’ initiative, which saw people who had been sleeping rough housed in temporary accommodation during the COVID-19 pandemic (DDN, May, page 5). London-wide partners were able to deliver hep C testing in hotels and hostels, as well as on the streets, and the document analyses cross-London data and includes interviews with people involved in setting up and delivering the initiatives.
By November, more than 40 people had started hep C treatment, demonstrating the importance of continued hep C testing outreach for the homeless population if London is to meet the NHS England target for elimination by 2025, says LJWG. The homeless population is disproportionately affected by hep C, with the mean age of death more than 30 years lower than for the general population. More than 40 per cent of those tested had been homeless for less than six months.
‘We know that hepatitis C disproportionately affects some of the most vulnerable and under-served people in our society, including people who are homeless and people who inject drugs,’ said senior health adviser to the Mayor of London, Dr Tom Coffey. ‘With an impressive partnership approach across healthcare, charities and the GLA, London has been able to offer hepatitis C testing and treatment, alongside other important healthcare interventions, throughout the pandemic lockdown period to people who are homeless. If London is to eliminate hepatitis C before 2025, testing and treatment must continue despite COVID-19. The model developed for testing in the last few months presents a fantastic opportunity to continue this progress.’
‘We could never have imagined when we launched our Routemap to eliminating hepatitisC (DDN, May, page 10) how the world would have changed by 2021,’ added LJWG coordinator Dee Cunniffe. ‘And yet thanks to the incredible hard work and innovation of everyone working on the BBV testing initiative in London, we have continued to find and treat people for hepatitis C, contributing significantly towards national elimination efforts.’
The initiative stands in contrast to the findings of a PHE report on the impact of COVID-19 on more widespread testing and care for people with viral hepatitis and HIV, which found a reduction in hepatitis testing in drug services, prisons, general practice and sexual health services, along with a reduction in diagnoses and hep C treatment starts. ‘Numbers of consultations, vaccinations, tests, diagnoses, and treatment initiations in the summer of 2020 were considerably lower than in corresponding months in 2019,’ it says.
While online and phone initiatives had the potential to increase access to testing it was important to make sure that services remain accessible to underserved populations such as people who inject drugs, homeless populations, sex workers and prisoners, PHE states.
Hepatitis C testing and treatment interventions for the homeless population in London during the COVID-19 pandemic: Outcomes and learning at http://ljwg.org.uk/
The impact of the COVID-19 pandemic on prevention, testing, diagnosis and care for sexually transmitted infections, HIV and viral hepatitis in England at www.gov.uk