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Drug Use, Homelessness Double HCV Reinfection Risk

Hepatitis C reinfection rates were high among a population of people who had experienced homelessness but increased even more among those experiencing homelessness at the time of treatment, researchers found.

“The primary care-based hepatitis C treatment program at Boston Health Care for the Homeless Program works to share its experience and outcomes,” Marguerite Beiser, ANP-BC, director of Hepatitis C Virus (HCV) Services at the Boston Health Care for the Homeless Program, told Healio. “We believe that describing the unique successes and challenges we encounter caring for this highly vulnerable population can help us devise better systems to meet their unique needs.”

She added, “Anecdotally, we knew our patients were experiencing reinfection, and we wanted to explore this outcome.”

Beiser and colleagues conducted a time-to-event analysis to understand reinfection risk over time among what she said is the “biggest homeless-experienced community-based cohort in published literature.”

According to the study, the researchers assessed people receiving HCV direct-acting antiviral treatment through the Boston Health Care for the Homeless Program between 2014 and 2020 with post-treatment follow-up assessments. HCV reinfection was identified based on recurrent HCV RNA following SVR.

Overall, 535 people were included in the study — 70% of whom were facing homelessness or unstable housing at treatment initiation. A total of 74 HCV reinfections were detected, including five second reinfections.

According to the study, HCV reinfection rate was 12/100 person-years (95% CI, 9.5-15.1) overall, 18.9/100 person-years (95% CI, 13.3-26.7) among individuals with unstable housing, and 14.6/100 person-years (95% CI, 10-21.3) among those experiencing homelessness.

Beiser added that the risk of reinfection increased to 25/100 person-years among people experiencing homelessness or unstable housing and reporting recent drug use before their HCV treatment.

An adjusted analysis showed that experiencing homelessness vs. stable housing (adjusted HR = 2.14; 95% CI, 1.09-4.2) and drug use within 6 months before treatment (aHR = 5.23; 95% CI, 2.25-12.13) were associated with increased reinfection risk.

“In the near-term, expansion and reinforcement of HCV care, including post-treatment care that is closely integrated within routine care structure in which people are already engaged is urgently needed,” Beiser said, adding that individual-level social determinants of health and the systems-level factors that contribute to community transmission need to be addressed.

“Ultimately, housing, particularly permanent supportive housing, should be recognized as a primary intervention for HCV elimination,” she said.

By Caitlyn Stulpin

Reference: Beiser ME, at al. Clin Infect Dis. 2023; doi:10.1093/cid/ciad127.

Source: Healio