Theme: Epidemiology & Public Health Research Year: 2018
Background:
Unstable housing status affects drug-use behaviors, but little research exists on the direct
relationship between housing trajectories and hepatitis c virus (HCV) infection.
Methods:
HCV negative young adult (<30 years of age) people who inject drugs (PWID) were enrolled
into a prospective cohort (2003-2017) with quarterly behavioral and serological
assessments. Temporal trends were plotted to capture changes in housing status between
2000-2017 and HCV incidence rates estimated by percent time housed using Kaplan-Meier
methods. Cox proportional hazard models were used to assess the independent effect of
recent housing status and housing status patterns on time to HCV incident infection.
Results:
Among 721 participants a total of 235 incident HCV infections occurred over 963.84 personyears (cumulative incidence: 24.4/100py, 95% Confidence Interval (CI): 21.5, 27.7). An
inverse relationship between time housed and HCV incidence was observed (always
unhoused: 45.0/100py, 95%CI: 37.1, 54.5; variably housed: 18.0/100py, 95%CI: 15.0, 21.3;
and always housed: 7.2/100py, 95%CI: 3.0, 17.3). In Cox proportional hazard regression
models controlling for sex, age, and factors which could account for incident HCV infection,
those recently unhoused versus housed had a 1.6 greater hazard (95% CI: 1.1, 2.1); for
every 3-months of unstable housing the hazard for HCV incident infection increased by 6%
(aHR: 1.1, 95% CI: 0.8, 1.4). Further, compared to those always housed, those always
unhoused has a 4-times greater hazard of HCV infection (95%CI: 1.7, 10.2) and those with
varying housing trajectories a 2.4 times greater hazard (95%CI: 1.0, 5.8).
Conclusion:
Findings indicate both recent unstable housing and being chronically unhoused greatly
increases one’s risk for HCV infection in young adult PWID, but so does intermittent states of
being unhoused. Given the increasing rates of housing instability many cities are
experiencing, interventions focused on providing consistent long-term housing for people
engaged in substance has potential to significantly reduce new HCV infections.
Disclosure of Interest Statement:
KP reports funding from NIH, PCORI and CDC for HCV research. She also receives funding
from Gilead Sciences for HCV research unrelated to this project.