Abstract
BackgroundHepatitis C virus (HCV) screening has taken on new importance as a result of updated guidelines and new curative therapies. Relatively few studies have assessed HCV infection in homeless populations, and a minority include women. We assessed prevalence and correlates of HCV exposure in a cohort of homeless and unstably housed women in San Francisco, and estimated the proportion undiagnosed.MethodsA probability sample of 246 women were recruited at free meal programs, homeless shelters, and low-cost single room occupancy hotels in San Francisco; women with HIV were oversampled. At baseline, anti-HCV status was assessed using an enzyme immunoassay, and results compared in both HIV-positive and negative women. Exposures were assessed by self-report. Logistic regression was used to assess factors independently associated th HCV exposure.ResultsAmong 246 women 45.9% were anti-HCV positive, of whom 61.1% were HIV coinfected; 27.4% of positives reported no prior screening. Most (72%) women were in the ‘baby-boomer’ birth cohort; 19% reported recent injection drug use (IDU). Factors independently associated with anti-HCV positivity were: being born in 1965 or earlier (AOR) 3.94; 95%CI: 1.88, 8.26), IDU history (AOR 4.0; 95%CI: 1.68, 9.55), and number of psychiatric diagnoses (AOR 1.16; 95%CI: 1.08, 1.25).ConclusionsResults fill an important gap in information regarding HCV among homeless women, and confirm the need for enhanced screening in this population where a high proportion are baby-boomers and have a history of drug use and psychiatric problems. Due to their age and risk profile, there is a high probability that women in this study have been infected for decades, and thus have significant liver disease. The association with mental illness and HCV suggests that in addition increased screening, augmenting mental health care and support may enhance treatment success.
Highlights
Hepatitis C virus (HCV) screening has taken on new importance as a result of updated guidelines and new curative therapies
Using methods developed by Burman and Koegel [23], designed to recruit a representative sample of homeless individuals, women were systematically approached at free meal programs, homeless shelters, and low-cost single room occupancy (SRO) hotels selected with probability proportionate to the number of individuals served, and invited to participate in baseline screening at the study venue located in the Tenderloin neighborhood in downtown San Francisco
We did not measure HCV RNA in this study, based on other studies [43], including the National Health and Nutrition Examination Survey (NHANES) [10] showing that 75 to 82% of anti-HCV positive persons remain viremic, we estimate that 34.5 to 37.8% of women had chronic disease. This is potentially underestimated since some HIVpositive women may not have had detectable anti-HCV [44]. Due to their age and risk profile, there is a high probability that women in this study have been infected for decades, and many likely already have significant liver disease as well as other associated extra-hepatic comorbidities in addition to reduced quality of life [45, 46]
Summary
Hepatitis C virus (HCV) screening has taken on new importance as a result of updated guidelines and new curative therapies. Riskbased HCV testing guidance issued by the Centers for Disease Control and Prevention (CDC) in 1998, and the U.S Public Health Service and Infectious Diseases Society of America in 1999 [17, 18], was updated in 2012 by the CDC to include those born between 1945 and 1965 (the “baby boomers”) [19] It was endorsed by the United States Preventive Services Task Force in 2013 after research showed this age group accounts for a large proportion (75%) of chronic HCV infections diagnosed and have elevated risk of mortality [20, 21]. The purpose of this study was to determine the prevalence and correlates of HCV exposure in a wellcharacterized cohort of homeless and marginally housed women, and estimate the proportion of women with undiagnosed HCV exposure
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