Principle Investigator: Dr Ryan Buchanan, University of Southampton

Team: Professor Salim Khakoo, University of Southampton, Dr Mark Wright, University of Southampton

Starts: 1/4/22

Ends: 1/4/23

Aim:

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

Background:

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.

Design and Methods:

The intervention will be developed in sequential steps from usual care through to incentivised peer led referral. Data will be collected via interview-based survey, social network survey and semi-structured interviews in selected participants. Patients will be followed up via their routine clinical Hepatology data and a telephone consultation to reassess their alcohol consumption. Qualitative data will be analysed using thematic analysis. Associations between network characteristics and risk behaviours for liver disease will be evaluated via regression analyses. The number of PWAH engaging with liver services and change in alcohol consumption will be compared between the steps of the intervention.

Potential Impact:

This study will develop the SHIELD intervention so that it can feasibly be deployed in a trial setting. To our knowledge there have been no clinical trials to address liver disease in the homeless. If the SHIELD intervention proves to be effective it will help to address a significant health inequality.