Jamie Barnard may feel like a lab rat for the next six months as she gives herself weekly interferon injections that she hopes will keep her hepatitis C virus in check for the rest of her life.
Earlier this month, specialists hovered over Barnard as she pulled the trigger on the first injection pen in a conference room at Salt Lake City's Fourth Street Clinic, a health care center that caters to the homeless population and people who have recently transitioned into housing.
"Sometimes even with the best attitude and best intentions, there are tough side effects [from the treatment], and we'll help you get through those," said Robert Keller, a retired gastroenterologist who volunteers at Fourth Street Clinic.Those side effects can run the gamut from constant flu-like symptoms, muscle aches, paranoia, anxiety, depression and anger. They can be harsh enough to force some to abandon treatment.
Even sticking with the 24 weeks of interferon injections and oral doses of the companion drug ribavirin, Barnard stands about an 80 percent chance of being "cured," which means the virus lies dormant in her body unless her immune system is compromised.
"I'll be all right," Barnard said optimistically. "I've handled a lot of other things, I think I can handle this."
At age 19, Barnard contracted hepatitis C from intravenous drug use.
"I didn't care," she recalled. "The opportunity to change my mood, to get high, came along and that was what mattered."
Unaddressed, hepatitis C is a slowly progressive disease that wreaks havoc on the liver, Keller said.
Hal Cole, a retired gastroenterologist and Fourth Street volunteer who is also part of Barnard's care team, said that hepatitis C can lead to cirrhosis of the liver, which according to the National Institutes of Health, is the 12th leading cause of death by disease.
Now 31, Barnard suffered bouts of homelessness and drug addiction for more than a decade. She frequently found care at Fourth Street Clinic, one of the only options the homeless have with the exception of being rushed to hospital emergency rooms if they experience a medical crisis.
In October, Barnard was able to get into her own apartment and now works two jobs as she works to finish
a court-ordered sentence through the state's drug court program. "Am I going to get ornerier?" Barnard asked Cole and Keller during the recent session where she received her medication.
"The answer is yeah," Cole said. But, he assured her, if irritation and anger levels go off the charts, Sam Vincent, a nurse practitioner and Fourth Street volunteer, is available to take her call.
"He's our psych nurse, he can diagnose and prescribe," said Jennifer Hyvonen, the clinic's external affairs director.
The hepatitis C treatment can be costly. The clinic's patient assistance coordinator, Verthanial Benally, has worked to get a wide array of prescription medications at free or reduced costs for the clinic's steady stream of clients. Drugs are also donated, said Cole, enabling the clinic to provide hepatitis C shots to patients at no cost. Without the donations, one shot alone can cost $500.
"We'll spend $53,000 on drugs and vaccines and we'll dispense $2.7 million annually," Hyvonen said.
With an army of 450 volunteers, the Fourth Street Clinic operates on an annual budget of $7.2 million, Hyvonen said, with over $3 million of that total coming from donations.
The Fourth Street Clinic began administering hepatitis C treatments in April 2009. Within three years the clinic had screened 137 patients and accepted 22 for treatment.
Of that number, 11 completed their treatment course, Cole said, and five were considered "cured" in tests given six months after stopping treatment. Two showed recurrent virus at 6 months, and four still await their six-month follow-up blood test. Four more have started treatment since the end of April.
To Hyvonen, such milestones signal progress in the war she wages every day on behalf of clients transitioning out of homelessness.
"There can be a lot of residual effects of homelessness that people need help processing through to succeed in their new life hepatitis C is one of them," Hyvonen said. "The interferon clinic is one example of how by healing disease, you can heal homelessness."
For Barnard, the care and support she's received from Fourth Street Clinic over the years has been life-changing.
"It was really helpful just to have more positive reinforcement," Barnard said of the clinic's assistance and encouragement. "It was like a family away from family."