Marguerite E Beiser1, Kamala Smith2, Molly Ingemi3, Emma Mulligan4, Travis P Baggett5. 1. Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA 02118, USA. Electronic address: mbeiser@bhchp.org. 2. Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA 02118, USA. Electronic address: ksmith@bhchp.org. 3. Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA 02118, USA. Electronic address: molly.ingemi@umassmed.edu. 4. Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA 02118, USA. Electronic address: emulligan@bhchp.org. 5. Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, 780 Albany St., Boston, MA 02118, USA; Division of General Internal Medicine, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA; Department of Medicine, Harvard Medical School, 25 Shattuck St., Boston, MA 02115, USA. Electronic address: tbaggett@mgh.harvard.edu.
Abstract
BACKGROUND: Hepatitis C virus (HCV) infection prevalence is high among adults who experience homelessness but data on HCV treatment outcomes are limited in this population. We examined HCV treatment engagement and outcomes in a cohort of homeless-experienced adults treated through an innovative community-based primary care program in Boston, Massachusetts, USA. METHODS: We conducted a retrospective chart review of individuals referred for HCV treatment at Boston Health Care for the Homeless Program (BHCHP) from January 2014 to March 2017. We assessed HCV treatment initiation, treatment completion, sustained virologic response (SVR), and reinfection rates. We conducted univariate and multivariable logistic regression analyses to examine the predictors of these outcomes. RESULTS: Of 510 referred for HCV treatment, 210 (41.1%) did not initiate treatment, principally because of being lost to follow-up (N = 93) or having superseding social issues (N = 49). Of 300 who initiated treatment, 80% were male, 52.3% were non-white, and 29% were homeless. Over half (58.6%) had a history of opioid use disorder (OUD). Twenty percent had cirrhosis. Treatment was completed by 285 (95.0%) individuals, and 255 (85.0%) achieved SVR. In multivariable analyses, individuals with bipolar disorder (OR 0.38, 95% CI 0.15-0.99), treated (OR 0.36, 95% CI 0.14-0.96) or untreated (OR 0.18, 95% CI 0.05-0.57) OUD, or on-treatment insurance change (OR 0.16, 95% CI 0.04-0.67) were less likely to achieve SVR, while individuals living with HIV (OR 10.43, 95% CI 1.33-81.96) were more likely to achieve SVR. Among 126 individuals with post-SVR follow-up data, 27 reinfections were identified during 206 person-years of follow up (rate 13.1 per 100 person-years). CONCLUSION: Homeless-experienced individuals initiating HCV treatment in a community-based program achieved high rates of treatment completion and SVR, but a large proportion did not initiate treatment. Individuals with OUD experienced lower but still substantial rates of cure. Treatment strategies targeting homeless-experienced people should focus on improving initial engagement and minimizing reinfection risk following treatment.
BACKGROUND:Hepatitis C virus (HCV) infection prevalence is high among adults who experience homelessness but data on HCV treatment outcomes are limited in this population. We examined HCV treatment engagement and outcomes in a cohort of homeless-experienced adults treated through an innovative community-based primary care program in Boston, Massachusetts, USA. METHODS: We conducted a retrospective chart review of individuals referred for HCV treatment at Boston Health Care for the Homeless Program (BHCHP) from January 2014 to March 2017. We assessed HCV treatment initiation, treatment completion, sustained virologic response (SVR), and reinfection rates. We conducted univariate and multivariable logistic regression analyses to examine the predictors of these outcomes. RESULTS: Of 510 referred for HCV treatment, 210 (41.1%) did not initiate treatment, principally because of being lost to follow-up (N = 93) or having superseding social issues (N = 49). Of 300 who initiated treatment, 80% were male, 52.3% were non-white, and 29% were homeless. Over half (58.6%) had a history of opioid use disorder (OUD). Twenty percent had cirrhosis. Treatment was completed by 285 (95.0%) individuals, and 255 (85.0%) achieved SVR. In multivariable analyses, individuals with bipolar disorder (OR 0.38, 95% CI 0.15-0.99), treated (OR 0.36, 95% CI 0.14-0.96) or untreated (OR 0.18, 95% CI 0.05-0.57) OUD, or on-treatment insurance change (OR 0.16, 95% CI 0.04-0.67) were less likely to achieve SVR, while individuals living with HIV (OR 10.43, 95% CI 1.33-81.96) were more likely to achieve SVR. Among 126 individuals with post-SVR follow-up data, 27 reinfections were identified during 206 person-years of follow up (rate 13.1 per 100 person-years). CONCLUSION: Homeless-experienced individuals initiating HCV treatment in a community-based program achieved high rates of treatment completion and SVR, but a large proportion did not initiate treatment. Individuals with OUD experienced lower but still substantial rates of cure. Treatment strategies targeting homeless-experienced people should focus on improving initial engagement and minimizing reinfection risk following treatment.
Authors: Jesse Powell; Margaret Ricco; Jessica Naugle; Catherine Magee; Hayat Hassan; Carmen Masson; Grace Braimoh; Barry Zevin; Mandana Khalili Journal: Open Forum Infect Dis Date: 2021-09-25 Impact factor: 3.835
Authors: Lamia Y Haque; Jenna L Butner; Julia M Shi; Susan Henry; Yanhong Deng; Maria M Ciarleglio; Lynn M Madden; Jeanette M Tetrault Journal: J Addict Med Date: 2022 May-Jun 01 Impact factor: 4.647
Authors: Daniel Winetsky; Daniel Burack; Pantelis Antoniou; Bill Garcia; Peter Gordon; Matthew Scherer Journal: J Infect Dis Date: 2020-09-02 Impact factor: 5.226
Authors: A Seaman; C A King; T Kaser; A Geduldig; W Ronan; R Cook; B Chan; X A Levander; K C Priest; P T Korthuis Journal: Int J Drug Policy Date: 2021-07-27