© 2023 KALW 91.7 FM Bay Area
KALW Public Media / 91.7 FM Bay Area
Play Live Radio
Next Up:
0:00
0:00
Available On Air Stations
Crosscurrents is our award-winning radio news magazine, broadcasting Mondays through Thursdays at 11 a.m. on 91.7 FM. We make joyful, informative stories that engage people across the economic, social, and cultural divides in our community. Listen to full episodes at kalw.org/crosscurrents

Hep C treatment van makes cure accessible to those who need it most.

 Alexander Gardner recently completed Hepatitis C treatment with the deLIVER Care van.
Angela Johnston
/
Alexander Gardner recently completed hepatitis C treatment with the deLIVER Care van.

Yesenia Laguardia has only been a phlebotomist for a few years, but around here she's known as a vampire.

“And that's a compliment in this community because we're able to get that blood,” she says as she sits down with Frederick Black outside the Windsor Hotel on Eddy Street.

“All right, go ahead and make a fist,” she tells him. “Squeeze and release, squeeze and release, do that about seven times.”

She ties a blue piece of rubber around Frederick’s arm and asks him to flex. Frederick used drugs for years, and is skeptical Yesenia will be able to find a vein that will work. But, Yesenia pokes a vein on his arm and within seconds blood begins to flow into a small vile.

There you go, girl,” Frederick says. “The first person to hit me on the first try.”

She says, it’s her patients who have taught her how to be such a great phlebotomist. They know their veins best and often help her get creative.

I've gone in and knuckles and we go in the hands. We're big on foot draws.”

Yesenia stops the flow, blots Fredericks’ arm with a cotton swab, bandages it up, and will send the blood to the lab later today. She works for the Hepatitis C testing and treatment program at UCSF, but most days she’s out here in the Tenderloin, on a shuttle bus converted into a phlebotomy station and hep C clinic. It’s called the deLIVER Care van.

 Volunteers set up the van on a Friday morning, outside the Windsor SRO hotel in the Tenderloin.
Angela Johnston
/
Volunteers set up the van on a Friday morning, outside the Windsor SRO hotel in the Tenderloin.

Frederick says he’s aware of his hep C status. He’s pretty sure he got it decades ago, from a tattoo gun or ink that wasn’t disinfected properly. But he didn’t get treatment. Back then, treating hepatitis C required extremely strong injections of a drug called interferon, with awful side effects. He tells Yesenia it initially turned him off of getting help.

About a decade ago, treatment changed. Now, the drugs are now milder and more effective. But today, for Black, it was largely the convenience that sold him.

I don't have to go chasing it. It came to me,” he says.

Every Friday, the deLIVER Care van parks here outside of his SRO. He can pick up his weekly supply of pills, get blood draws to chart his progress, and even get an ultrasound scan of his liver to see if he’s developed scaring, all just outside his building.

They made it very, very, very accessible.”

This was Dr. Jennifer Price’s motivation for starting the deLIVER Care program back in 2019. She’s a liver specialist at UCSF. When treatment changed from those tough interferon injections to two to three months of antiviral pills, that gave Dr. Price a lot of hope.

We were able to essentially cure all of our patients with hepatitis C who came to the clinic, who knew they had hepatitis C, who were eager to get started on treatment and who were able to get insurance authorization for treatment,” she says.

But there was a disconnect with the potential, and the reality. There was still a large population of people living with untreated hepatitis C. In San Francisco, that meant people who were experiencing homelessness, people who were using drugs. And Dr. Price says, they’re the ones that often need treatment the most.

It's really two epidemics at the same time that are coexisting, an epidemic of opioid use disorder and other substance use, and an epidemic of hepatitis C.”

And the people caught in the middle are much less likely to go see a doctor. They have competing priorities, like finding a place to live. They may not have insurance or a primary care doctor. Or they feel judged by the medical system for still using drugs. In the past, you could be denied hep C treatment if a drug test came back positive. In California, that’s no longer the case, but Dr. Price says there’s still a lot of misinformation out there. So, she wanted the deLIVER Care van to eliminate as many hurdles as possible. Phlebotomist Yesenia Laguardia says they first partnered with SROS, then methadone clinics.

“We pick sites where we believe our patient population frequents. We bring treatment to them.”

There are other places that do hep C testing throughout the city, but often a patient has to go somewhere else to get treated. The van does it all.

“Every time they have to pick up medication, they come to the van. Any blood draw…it's done by the same phlebotomists on the van.”

And they’ll get creative. Like if a patient doesn’t have a phone for a reminder, they’ll leave post-its on their door the day before. Or, for a patient who didn’t have a place to store her meds, Yesenia made a necklace with a week’s supply of pills attached in little plastic baggies.

Yesenia Laguardia
/
The deLIVER van tries to make treatment as convenient for patients as possible.

She would keep it on her…she would take the little Ziploc off of it and take one pill a day, and she worked really hard and eventually we got her results back and she got cured too. So it's been very nice to be able to adjust to what the patient needs from us,” Yesenia says.

Those video doctors appointments we all got used to in the last two years? They’re on the van, too.

“Anytime they would see a need to see a clinician, it would be done over the video, over the computer on the van as well.”

When I visit the van one week last December, Alexander Gardner is having one of those appointments. He found the deLIVER van because it was right around the corner from his methadone clinic in the SOMA.

I go get my dose, I'll get my dose of methadone every day. So I saw a great opportunity for me to go to get this Hepatitis treated. I figured, well, I should go in and at least see if I got it or not, you know? So that's what I did,” he says.

Alexander is 70 years old. He says he’s been taking methadone for 18 years, after he quit using heroin. But all that time, he was also living with hep C.

I must have used some outfit or a syringe after someone. And I think that’s the way I got it. Matter of fact, I'm almost sure that’s where I got it.”

He took one pill a day for three months. Today he stopped by to video chat with a nurse practitioner to hear about the results of a recent blood test.

The nurse practitioner says the blood test results show that the hepatitis C virus is not detected. “My goodness, that's beautiful,” Alexander replies.

The virus wasn’t detected, which means he is almost cured. They’ll do another blood draw in a month, and if the virus still doesn’t show up, it means he’s officially Hep C free.

“I'm glad I got the treatment because it made me feel more energetic, but I think that hepatitis C was trying to take me out.” Alexander says he also feels more empowered to take control of his health.

“It gives me a sense that I'm doing something right in my life for a change.”

That sense of accomplishment that comes with a cure can also make people more comfortable with accessing other types of healthcare. The van has built a strong partnership with other organizations in the city. Often after establishing trust, they’ll set patients up with primary care doctors or refer them to specialty clinics at San Francisco General.

In just over three years, the van has treated about 60 people and almost 100 more are on their way to being cured. According to Dr. Jennifer Price, almost all of the vans’ patients are cured if they complete treatment. Yesenia says it’s inspiring.

We get told often that it'd be cool if our van can offer more.”

The deLIVER Care team hopes these other public health advocates, like the people giving out Suboxone for opioid withdrawal or delivering HIV medication, can look to the success of the van, and bring more treatment to the street.