Theme: Epidemiology & Public Health Research Year: 2019
Background: Among people who inject drugs (PWID), there is evidence that homelessness is
associated with increased risk of hepatitis C virus (HCV) infection. We used a large cross-sectional
survey of PWID in the UK, to test whether homelessness is associated with increased risk of hepatitis
C exposure and if this difference could be explained by injecting practices, contact with harm
reduction services, and incarceration.
Methods: We used secondary anonymised data from the Unlinked Anonymous Monitoring Survey of
HIV and Viral Hepatitis (UAMS) from 2012 to 2017. We excluded participants who did not inject in
the past year and those aged under 16 or over 64, resulting in a dataset of 11,101 individuals.
We conducted a logistic regression analysis, with HCV exposure (measured as antibody positive in a
dried blood spot test) as the dependent variable and lifetime experience of homelessness as the
independent variable, subsequently adding potential mediators.
78% reported ever experiencing homelessness, with 52% having HCV antibodies, compared to 38%
of the never homeless PWIDs. The odds of HCV exposure among participants who were everhomeless was 2.2 (95% CI 2.0-2.4), adjusted for age and sex. Participants with lifetime experience of
homelessness were more likely to inject both opiates and stimulants, inject every day, inject in a
risky site such as the neck or groin, and were more likely to have been incarcerated. After adjusting
for these factors, the odds ratio was 1.56 (95% CI 1.41-1.73), suggesting that the mediators included
explain 41% of the difference in HCV exposure.
This study is one of the largest exploring homelessness and HCV exposure. The majority of PWID in
this study experienced homelessness, with higher risk of HCV exposure. The mediation results
provide evidence that prisons may be an important location for health promotion interventions that
address the higher risk of HCV among homeless PWID.
Disclosure of Interests Statement
Dr Binta Sultan and Dan Lewer are funded by the National Institute of Health Research (NIHR). Julian
Surey has received funding for projects from Gilead. No pharmaceutical grants were received in the
development of this study.