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ADOPTED PROJECT: Social network facilitated engagement in people who are Homeless to address InEqualities in alcohol related Liver Disease - The SHIELD feasibility study

Principle Investigator: Dr Ryan Buchanan, University of Southampton

Team: Professor Salim Khakoo, University of Southampton, Dr Mark Wright, University of Southampton, Dr Yun J Kim, University Hospital Southampton NHS Foundation Trust.

Starts: 1/4/22

Ends: 1/4/23


To develop and assess the feasibility of a social network-based intervention to engage people who are homeless and at risk of alcohol-related liver disease with Hepatology services


Mortality in people who are homeless (PWAH) is eight times higher than the general population and liver cirrhosis is the third commonest cause of death. PWAH infrequently access hospital based Hepatology services for assessment. Alcohol consumption is a socially perpetuated behaviour that is known to cluster within human social networks.

What we did

Recruitment continued from February to July 2022 of people who are homeless with high risk of alcohol dependence (AUDIT score) were identified in hostels and at a homeless day centre in Southampton. Those people were then asked to take part in tests and to refer thier drinking partners to the programme. They were given supermarket vouchers as an incentive.

Those homeless people who took part, filled in a survey and took part in an interview. They also had a test on their liver and were referred to liver health services.

What did we find out?

Fifty six peoople took part, all were from homeless hostels. Almost 20% of the group had a new diagnosis of cirrhosis, and there was a link between people who had type 2 diabetes or lived house where alcohol was present.

  • Homeless people with hazardous alcohol consumption are socially connected to others that drink dangerously.

  • This programme of referral can identify undiagnosed disease, however, engagement via trusted staff may be just as effective.

  • The study highlights the importance of working with community organisations supporting underserved populations to overcome inequalities in liver disease and manage multi-morbidity.

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