Article

Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in Los Angeles

University of California at Los Angeles, David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA 90024, USA.
Public Health Reports (Impact Factor: 1.64). 07/2012; 127(4):407-21.
Source: PubMed

ABSTRACT We documented the prevalence, distribution, and correlates of hepatitis C virus (HCV) infection among urban homeless adults.
We sampled a community-based probability sample of 534 homeless adults from 41 shelters and meal programs in the Skid Row area of downtown Los Angeles, California. Participants were interviewed and tested for HCV, hepatitis B, and HIV. Outcomes included prevalence, distribution, and correlates of HCV infection; awareness of HCV positivity; and HCV counseling and treatment history.
Overall, 26.7% of the sample tested HCV-positive and 4.0% tested HIV-positive. In logistic regression analysis, independent predictors of HCV infection for the total sample included older age, less education, prison history, and single- and multiple-drug injection. Among lifetime drug injectors, independent predictors of HCV infection included older age, prison history, and no history of intranasal cocaine use. Among reported non-injectors, predictors of HCV infection included older age, less education, use of non-injection drugs, and three or more tattoos. Sexual behaviors and snorting or smoking drugs had no independent relationship with HCV infection. Among HCV-infected adults, nearly half (46.1%) were unaware of their infection.
Despite the high prevalence of HCV infection, nearly half of the cases were hidden and few had ever received any HCV-related treatment. While injection drug use was the strongest independent predictor, patterns of injection drug use, non-injection drug use, prison stays, and multiple tattoos were also independent predictors of HCV. Findings suggest that urgent interventions are needed to screen, counsel, and treat urban homeless adults for HCV infection.

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    • "Injection drug users (IDUs) have a high prevalence of viral hepatitis A, B, and C infection (HAV, HBV, HCV) in the U.S. (Hutin et al. 2005; Kuo, Sherman, Thomas, & Strathdee, 2004; Hennessey, Bangsberg, Weinbaum, & Hahn, 2009; Nelson et al., 2011). However, many IDUs do not know their HAV, HBV, and HCV serostatus (Carey et al. 2005; Gelberg et al. 2012; Reimer et al. 2006; Roblin, Smith, Weinbaum, & Sabin, 2011; Southern et al. 2011), may miss opportunities for prevention, and may be more likely to transmit these viruses to both drug using contacts and to non-drug using sexual and close contacts (Kuo et al. 2004; Thiede et al. 2007). While drug treatment programs are an ideal setting for viral hepatitis education, viral hepatitis is poorly addressed in U.S. opioid replacement therapy programs. "
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