Hospital Universitario Infanta Leonor, Madrid, Spain.
Universidad Complutense de Madrid, Madrid, Spain.
JAMA Netw Open. 2024 Oct 1;7(10):e2438657. doi: 10.1001/jamanetworkopen.2024.38657.
Hepatitis C virus (HCV) microelimination aims to detect and treat hidden infections, especially in at-risk groups, like people experiencing homelessness (PEH) with alcohol or drug use disorders. Point-of-care HCV RNA testing and peer support workers are crucial for identifying and preventing HCV infection among marginalized populations, contributing to overall elimination goals.
To assess risk factors, prevalence, and trends of active HCV infection among PEH in Madrid, Spain (2019-2023).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study was conducted between 2019 and 2023 in PEH, defined as people who lacked a fixed, regular, and adequate night residence, screened on the street or in homeless shelters via mobile unit using rapid HCV antibody testing, followed by HCV-RNA testing in Madrid, Spain. Data were analyzed from January to June 2024.
Active HCV infection among PEH was the main outcome. Risk factors analyzed included being born outside of Spain, alcohol misuse, lacking financial income, benzodiazepine use, injection drug use (IDU; including nonactive IDU and active IDU within the last year), opioid substitution therapy participation, and sexual behavior patterns. Data were analyzed using logistic regression. P values were adjusted for multiple testing using the false discovery rate (q-values).
A total of 4741 individuals were screened for HCV infection, of whom 2709 (mean [SD] age, 42.2 [12.7]; 1953 [72.2%] men) were PEH and included in analysis. A total of 363 PEH (13.4%) had test results positive for HCV antibodies, of whom 172 (47.4%) had test results positive for HCV-RNA, and 148 of these (91.9%) started HCV treatment. Overall, active HCV infection prevalence was 6.3%, and the main risk factors associated with active HCV infection included IDU, encompassing both nonactive IDU (adjusted odds ratio [aOR], 10.9; 95% CI, 6.1-19.4; q < .001) and active IDU in the last year (aOR, 27.0; 95% CI, 15.2-48.0; q < .001); a lack of financial income (aOR, 1.8; 95% CI, 1.1-2.9; q = .03); and alcohol misuse (aOR, 1.8; 95% CI, 1.3-2.6; q = .008). There was a significant decrease between 2019 and 2023 in active HCV infection prevalence across the entire population, from 7.2% to 3.4% (P = .04).
In this cross-sectional study of PEH in Madrid, IDU, lack of income, and alcohol misuse were primary risk factors associated with HCV infection. The significant decline in HCV rates observed across all risk groups during the study period suggests preventive policies were effective in reducing HCV prevalence among the homeless population.
丙型肝炎病毒 (HCV) 微消除旨在检测和治疗隐匿性感染，特别是在有风险的群体中，如有酒精或药物使用障碍的无家可归者 (PEH)。即时检测 HCV RNA 和同伴支持工作者对于识别和预防边缘化人群中的 HCV 感染至关重要，有助于实现总体消除目标。
评估西班牙马德里的 PEH 中丙型肝炎病毒活跃感染的风险因素、流行率和趋势（2019-2023 年）。
设计、地点和参与者：这是一项横断面研究，于 2019 年至 2023 年期间在 PEH 中进行，定义为缺乏固定、定期和足够夜间住所的人，通过移动单位在街头或无家可归者收容所进行快速 HCV 抗体检测筛查，然后在西班牙马德里进行 HCV-RNA 检测。数据分析于 2024 年 1 月至 6 月进行。
PEH 中的丙型肝炎病毒活跃感染是主要结局。分析的风险因素包括出生在西班牙境外、酒精滥用、缺乏经济收入、苯二氮䓬类药物使用、注射吸毒（包括非活跃的 IDU 和过去一年中活跃的 IDU）、阿片类药物替代治疗参与和性行为模式。使用逻辑回归分析数据。使用虚假发现率 (q 值) 对多重检验进行调整后，p 值。
共有 4741 人接受了 HCV 感染筛查，其中 2709 人（平均 [SD] 年龄，42.2 [12.7]；1953 [72.2%] 男性）为 PEH，并纳入分析。共有 363 名 PEH（13.4%）的 HCV 抗体检测结果呈阳性，其中 172 名（47.4%）的 HCV-RNA 检测结果呈阳性，其中 148 名（91.9%）开始接受 HCV 治疗。总体而言，丙型肝炎病毒活跃感染的流行率为 6.3%，与丙型肝炎病毒活跃感染相关的主要风险因素包括注射吸毒，包括非活跃的 IDU（调整后的优势比 [aOR]，10.9；95%CI，6.1-19.4；q <.001）和过去一年中活跃的 IDU（aOR，27.0；95%CI，15.2-48.0；q <.001）；缺乏经济收入（aOR，1.8；95%CI，1.1-2.9；q =.03）；以及酒精滥用（aOR，1.8；95%CI，1.3-2.6；q =.008）。整个研究期间，丙型肝炎病毒活跃感染的流行率从 2019 年的 7.2%显著下降至 2023 年的 3.4%（P =.04）。
在马德里的这项 PEH 横断面研究中，IDU、缺乏收入和酒精滥用是与 HCV 感染相关的主要风险因素。在研究期间，所有风险群体中 HCV 率的显著下降表明，预防政策在降低无家可归人群中的 HCV 流行率方面是有效的。
