Page Kimberly, Yu Michelle, Cohen Jennifer, Evans Jennifer, Shumway Martha, Riley Elise D
Division of Epidemiology, Biostatistics & Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10 5550; 1 University of New Mexico, Albuquerque, NM, USA.
Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, USA.
BMC Public Health. 2017 Feb 7;17(1):171. doi: 10.1186/s12889-017-4102-5.
Hepatitis C virus (HCV) screening has taken on new importance as a result of updated guidelines and new curative therapies. Relatively few studies have assessed HCV infection in homeless populations, and a minority include women. We assessed prevalence and correlates of HCV exposure in a cohort of homeless and unstably housed women in San Francisco, and estimated the proportion undiagnosed.
A probability sample of 246 women were recruited at free meal programs, homeless shelters, and low-cost single room occupancy hotels in San Francisco; women with HIV were oversampled. At baseline, anti-HCV status was assessed using an enzyme immunoassay, and results compared in both HIV-positive and negative women. Exposures were assessed by self-report. Logistic regression was used to assess factors independently associated th HCV exposure.
Among 246 women 45.9% were anti-HCV positive, of whom 61.1% were HIV coinfected; 27.4% of positives reported no prior screening. Most (72%) women were in the 'baby-boomer' birth cohort; 19% reported recent injection drug use (IDU). Factors independently associated with anti-HCV positivity were: being born in 1965 or earlier (AOR) 3.94; 95%CI: 1.88, 8.26), IDU history (AOR 4.0; 95%CI: 1.68, 9.55), and number of psychiatric diagnoses (AOR 1.16; 95%CI: 1.08, 1.25).
Results fill an important gap in information regarding HCV among homeless women, and confirm the need for enhanced screening in this population where a high proportion are baby-boomers and have a history of drug use and psychiatric problems. Due to their age and risk profile, there is a high probability that women in this study have been infected for decades, and thus have significant liver disease. The association with mental illness and HCV suggests that in addition increased screening, augmenting mental health care and support may enhance treatment success.
由于指南更新和新的治愈性疗法，丙型肝炎病毒（HCV）筛查具有了新的重要性。相对较少的研究评估了无家可归人群中的HCV感染情况，而且少数研究纳入了女性。我们评估了旧金山一群无家可归和住房不稳定女性中HCV暴露的患病率及其相关因素，并估计了未被诊断出感染的比例。
从旧金山的免费膳食项目、无家可归者收容所和低成本单人居住酒店中招募了246名女性的概率样本；对感染HIV的女性进行了过度抽样。在基线时，使用酶免疫测定法评估抗HCV状态，并在HIV阳性和阴性女性中比较结果。通过自我报告评估暴露情况。使用逻辑回归评估与HCV暴露独立相关的因素。
在246名女性中，45.9%抗HCV呈阳性，其中61.1%合并感染HIV；27.4%的阳性者报告之前未进行过筛查。大多数（72%）女性属于“婴儿潮”出生队列；19%报告近期有注射吸毒史（IDU）。与抗HCV阳性独立相关的因素有：1965年或更早出生（比值比[AOR] 3.94；95%置信区间[CI]：1.88，8.26）、有注射吸毒史（AOR 4.0；95%CI：1.68，9.55）以及精神疾病诊断数量（AOR 1.16；95%CI：1.08，1.25）。
研究结果填补了关于无家可归女性中HCV信息的重要空白，并证实了在这一人群中加强筛查的必要性，该人群中很大一部分是婴儿潮一代且有吸毒史和精神疾病问题。由于她们的年龄和风险状况，本研究中的女性很可能已感染数十年，因此患有严重肝病。精神疾病与HCV的关联表明，除了加强筛查外，增加精神卫生保健和支持可能会提高治疗成功率。
