Hepatitis C among vulnerable populations: A seroprevalence study of homeless, people who inject drugs and prisoners in London

Abstract

Injecting drugs substantially increases the risk of hepatitis C virus (HCV) infection and is common in the homeless and prisoners. Capturing accurate data on disease prevalence within these groups is challenging but is essential to inform strategies to reduce HCV transmission. The aim of this study was to estimate the prevalence of HCV in these populations. We conducted a cross-sectional study between May 2011 and June 2013 in London and, using convenience sampling, recruited participants from hostels for the homeless, drug treatment services and a prison. A questionnaire was administered and blood samples were tested for hepatitis C. We recruited 491 individuals who were homeless (40.7%), 205 drug users (17%) and 511 prisoners (42.3%). Eight per cent of patients (98/1207, 95% CI: 6.7%-9.8%) had active HCV infection and 3% (38/1207, 95% CI: 2.3%-4.3%) past HCV infection. Overall, one quarter (51/205) of people recruited in drug treatment services, 13% (65/491) of people from homeless residential sites and 4% (20/511) prisoners in this study were anti-HCV positive. Seventy-seven of the 136 (56.6%, 95% CI: 47.9%-65%) of HCV infected participants identified had a history of all three risk factors (homelessness, imprisonment and drug use), 27.3% (95% CI: 20.1%-35.6%) had 2 overlapping risk factors, and 15.4% (95% CI: 10.6%-23.7%) one risk factor. Drug treatment services, prisons and homelessness services provide good opportunities for identifying hepatitis C-infected individuals. Effective models need to be developed to ensure case identification in these settings that can lead to an effective treatment and an efficient HCV prevention.

Hepatitis C virus testing, liver disease assessment and direct‐acting antiviral treatment uptake and outcomes in a service for people who are homeless in Sydney, Australia: The LiveRLife homelessness study

“…Comparable to previous studies HCV RNA prevalence among the study population was high (23%), however, the majority of participants with HCV infection reported a history of injection drug use. Consistent with previous research, there was a strong relationship between reported HCV risk factors (history of injecting drug use or incarceration) and HCV RNA prevalence . In fact, the majority (n = 25, 63%) of those with HCV infection had a history of injecting and incarceration.…”

Prevalence of HCV infection in a prison population of the greater Florianópolis area

“…The goal of the present study was to estimate the prevalence of HCV infection in the prison population in the greater Florianópolis area. Studies such as the present study may promote the improvement and development of strategies to reduce HCV transmission 3 .…”

Leaving behind pegylated interferon‐based regimens to eliminate hepatitis C as a public health threat by 2030 as set out by WHO

“…HCV outcomes are clearly influenced by other axes of inequality and characteristics of health systems, leading to syndemic interactions beyond that between HCV and HIV, for example, race/ethnicity and insurance status being associated with access to DAAs, marginalization of vulnerable populations (PWID, homeless persons, sex workers, etc.) with lower linkage‐to‐care figures, the current refugees crisis in the Mediterranean with high rates of undiagnosed HCV, or the opioid crisis in the USA with an increased number of acute HCV infections differently affecting PWID populations according to territory, age, gender, ethnicity or socioeconomic position . That is why we need to comprehensively study the social determinants of HCV epidemics globally and locally, design public policies, and integrated preventive strategies to approach them from the more structural causes of disease distribution to the more immediate risk factors, such as the sources of acquisition of HCV infection.…”