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Homeless shelters are on the frontlines of fighting hepatitis C

Gregory Davenport was addicted to heroin for 20 years. Along the way, he got hepatitis C.

"I don't know exactly how I got it, but probably sharing a needle or a cooker," Davenport says.

The virus festered in his body, eating away at his liver.

The disease, he says, "was a bomb inside of me, ready to explode at any time."

Although hepatitis C can cause liver disease, cirrhosis or liver cancer, Davenport avoided getting treatment. He knew the medications in use at that time had a reputation for having bad side effects.

Davenport eventually went to a drug rehab program. He's now nine months sober and living in transitional housing at the Midnight Mission on Los Angeles' Skid Row.

He's finally taking care of his hepatitis C.

He's getting that treatment through an unusual arrangement: While patients typically have to go to a liver specialist to get hepatitis C medication, Davenport is getting his at the Mission, through a health clinic run by Los Angeles Christian Health Centers.

The program at the Mission is part of a small but growing trend. Over the past two years, providers have started offering hepatitis C treatment at several homeless shelters in San Francisco and at needle exchange sites in Berkeley and Mendocino.

The Centers for Disease Control and Prevention estimates that among older and former intravenous drug users like Davenport, between 70 and 90 percent are infected with hepatitis C.

These initiatives are small steps toward solving a larger public health problem. IV drug users are the people most likely to spread hepatitis C — and they're the hardest to treat.

'Eliminates an extra barrier'

Backers of efforts like the one at the Midnight Mission say they're a promising solution because they offer treatment where people feel safe, where they know they won't feel stigmatized for using drugs or having Hepatitis C.

It's also more convenient for these patients, says Emalie Huriaux, director of federal and state affairs with Project Inform, which advocates for people with hepatitis C and HIV.

"Treatment provided where you already go, where you already are, just eliminates an extra barrier," Huriaux says. "Sometimes that extra bus trip across town can be the difference between going to the doctor and not going to the doctor."

These new models are possible because the new drugs are extremely effective and have few side effects. They're also very expensive.

Davenport gets his medication, Zepatier, covered through Medi-Cal. He's one month into the three-month treatment. He stores his pills in a locker at the Mission and takes one each night.

Jim Morgan is the other resident who's been treated for hepatitis C at the Mission. He developed his own system to remember to take his medication: He has posted a sign with bold, black letters in front of his television.

"It says, take my pill, 9 o'clock at night," he says with a laugh. "I can't miss it."

Morgan says he didn't have that amount of stability when he was homeless.

"Half the time I couldn't even take a shower every day, much less take a pill," he says. "Especially at the same time every day? No, it wouldn't have happened."

Shannon Fernando, the nurse practitioner for Los Angeles Christian Health Centers who's providing the treatment at the Mission, says there are more benefits to offering treatment at the shelter.

It's helpful to say to patients, "Hey, you're living upstairs. Come down to the clinic. Let me check in with you, see how you're doing," Fernando says. "If they don't have a phone, but they're living here, it's great. We just call upstairs, we leave them a note on their bunk and we're able to get ahold of them."

'Great news'

At a recent appointment, Fernando gives Davenport the results of his lab test.

"Great news! Your viral load is now undetectable," she says. "Just after four weeks, your virus is no longer there."

"Wow," Davenport murmurs in response.

The former heroin addict is wearing a collared shirt and a bow tie. He looks ready for his next step: A job as a patient advocate, helping people find housing and referring them to drug treatment programs.

"I'm doing it from my heart, because I know how it is to be homeless and have nothing," Davenport says. "I came here with nothing and now I'm just truly blessed."

Now that Davenport and Morgan are on the road to being cured, Fernando says she's preparing to ramp up the hepatitis C program at the Midnight Mission. She expects the organization will treat as many as 25 people by the end of the year.

Meanwhile, another group that works with the homeless, Homeless Health Care Los Angeles, is gearing up to provide hepatitis C treatment and medication at its needle exchange site on Skid Row.