Effect of homelessness and IVDU on Hepatitis C linkage to care
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It has been widely shown that intravenous drug use (IVDU) is a major risk factor for Hepatitis C Virus (HCV), and Hepatitis C remains highly prevalent among homeless populations. More data is needed to demonstrate the effectiveness of linkage to care and treatment programs within these high risk populations. Determining the social and clinical risk factors associated with lower rates of positive HCV clinical outcomes such as linkage and treatment can have a significant impact on patient outcomes and public health program success. A prospective cohort of 1254 subjects was used for these analyses. Log binomial regression models were created for the analysis of both homelessness and whether the patient has ever injected drugs (ever-IVDU) separately for their associations with linkage to HCV care. The cohort was 68% male and 32% female, with median age of 44 years old (range 18-90 years old). Thirty-five percent of the study population was inside the “baby boomer” birth cohort (born 1945-1965) which is considered to be a particularly high risk population. Four percent of the population was co-infected with Hepatitis B Virus and 6% were co-infected with HIV. Sixty-two percent of the cohort reported homelessness, and 78% had ever used IV drugs. Homeless individuals had an adjusted RR of 0.82 (95% CI: 0.70-0.91) and patients having ever used IV drugs had an adjusted RR of 1.06 (95% CI: 0.94–1.19) for the outcome of HCV linkage to care. The results of this study showed that homeless individuals had an 18% decreased risk of becoming linked to care compared to those that are not homeless, while ever- IVDU showed no significant association with linkage to care after controlling for confounding. With Hepatitis C being so prevalent among homeless populations, these results are especially helpful in informing linkage to care programs. Understanding the major barriers to care that these patients face is crucial to designing linkage and navigation programs that will successfully engage and benefit these patients.