Grant: Travel Awards - Institute Community Support

People with lived experiences of criminalization, including incarceration, homelessness, and substance use, face high rates of HIV and/or hepatitis C virus (HCV) infections and low treatment uptake in Canada. A significant barrier to care is the lack of having a cell phone, which hinders healthcare providers' ability to contact individuals and coordinate follow-up care. Test, Link, Call (TLC) Project aims to improve access to HIV and/or HCV care for people experiencing criminalization in British Columbia. Clients receive a cell phone with six-months unlimited talk and text and pre-installed health apps. They are also paired with peer health mentors (PHMs) to assist with navigating health services. A mixed-methods evaluation was conducted from October 2021-March 2024 to determine the outcomes and acceptability of TLC and its impact on care engagement. Qualitative data were collected using semi-structured interviews with healthcare providers (n=8), PHMs (n=6), and clients (n=20). Demographic and clinical data were collected using program records and cross-sectional clinical chart reviews. Factors associated with HCV treatment uptake were assessed among HCV RNA positive clients (n=245) using multivariate logistic regression. TLC enrolled 273 clients in HCV care and 26 in HIV care. Clients reported that TLC was highly acceptable, with increased access to health services, improved connections with loved ones, and enhanced independence and safety. Challenges included phone theft and digital literacy issues. Among HCV clients, 57% initiated treatment within 12 months of enrollment. Multivariate analysis identified cis-gendered men, stable housing, safer supply prescriptions, and longer program involvement as significant predictors of HCV treatment uptake. This evaluation demonstrates that the TLC Project significantly improves engagement in HIV and/or HCV care for people experiencing criminalization. The program can be adapted to other regions and health conditions.