An update of Hepatitis C prevalence rates in homeless adults after Hepatitis C treatment paradigm change: A systematic review and meta-analysis

Abstract

Background: An estimated 100 million people are homeless around the world. Concurrent vulnerabilities, such as psychiatric diseases, addictions with unsafe injection practices increase blood-borne infections risks, including HCV in homeless individuals. A 2012 Lancet Infectious Diseases paper reported HCV prevalence in homeless ranging from 3·9% to 36·2%, but we know very little about HCV treatment in homeless, aside from the fact that treatment is rarely if at all provided or considered. Old treatment regimens from the “interferon era” had many psychiatric side effects, including increased suicide and major depression rates and were contraindicated in patients, who had pre-existing or secondary psychiatric diseases, addictions, and were unstable. Meanwhile, treatment paradigm has changed in HCV management recently. Current HCV treatment options are not contraindicated in people with psychiatric conditions anymore and can help successfully achieve HCV cure. Additionally, new treatment options are shorter in duration, all-oral instead of injections with easier to adhere regimens, and are recommended by current guidelines in unstable individuals as well. This study objective is to update previous study findings, and examine HCV treatment prevalence in homeless adults. Methods: On February 2016, we searched PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature databases for “homeless* and (hepatitis C or HCV)” for studies reporting HCV prevalence in homeless adults published between 31 January 2012 and 15 February 2016. Meta-analysis was conducted following the PRISMA Checklist. Data was tabulated in Comprehensive Meta-Analysis. Findings: Fifteen epidemiological studies yielded. The omnibus prevalence rate for HCV in homeless remains unchanged since 2012, (28%; 95% CI: 23-34; N=15). Only three studies reported HCV treatment investigation, but the data quality could not allow a meta-analysis. Interpretation: Despite a high HCV prevalence among homeless, HCV treatment prevalence information is limited; some studies mention that treatment is not practically provided. This meta-analysis data can help to estimate the frequency of HCV infection, which can help to plan HCV management services for homeless population in a better way. Together with the recent advancements, paradigm changes in HCV treatment the data from this review can also contribute to the global HCV elimination goal.