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Undiagnosed HCV prevalent among homeless adults in Los Angeles

Hepatitis C is highly prevalent among homeless adults in urban areas, and almost half of the infected are unaware of their health status, according to recent results.

Researchers tested 534 homeless adults from 41 shelters and meal programs located in downtown Los Angeles for HCV, HBV and HIV to determine the prevalence of illness, participants’ awareness of their conditions and, if infected, their history of treatment and/or counseling. Participants also were questioned about their substance use and sexual behaviors.

Within the cohort, 26.7% tested positive for HCV and 4.0% tested positive for HIV, with 0.7% having both HCV and HIV. Among those who tested positive for HCV, 46.1% were unaware of their infection before the study; 35.5% reported undergoing previous testing for the illness. Among participants with prior knowledge of their HCV status, 39.5% had been referred for HCV-related care, 5.2% had received care and 3.1% presently were receiving care.

Being aged 40 years or older (OR=4.34; 95% CI, 2.12-8.88), prison history (OR=1.92; 95% CI, 1.10-3.34) and injection drug use (OR=12.54; 95% CI, 4.00-39.28 for single-drug and OR=27.10; 95% CI, 9.48-77.46 for multiple-drug injection) were independent predictors of HCV. Predictive factors among lifetime injection drug users included being aged 40 years or older (OR=3.64; 95% CI, 1.02-12.95), prison history (OR=4.55; 95% CI, 1.23-16.85) and intranasal cocaine use (OR=0.26; 95% CI, 0.08-0.87 for those using cocaine), while factors for noninjectors included aged 40 years or older (OR=4.69; 95% CI, 1.97-11.18), use of noninjection drugs (OR=3.08; 95% CI, 1.11-8.54 for drugs excluding marijuana) and having three or more tattoos (OR=2.75; 95% CI, 1.13-6.69).

“Homeless adults need interventions that include HCV education, counseling, voluntary testing, and treatment services,” the researchers wrote. “HCV prevention and treatment programs could be modeled after successful HIV/AIDS interventions developed for shelters, meal programs, health clinics, substance abuse treatment programs, outreach, and other service programs. If resources are limited, findings suggest that interventions prioritize urban homeless subgroups that are at the highest risk for HCV infection; that is, those with a history of injection drug use, time spent in prison and multiple tattoos.”