Top

Published in:

01-12-2019 | Hepatitis B | Original Paper

Community Screening, Identification, and Referral to Primary Care, for Hepatitis C, B, and HIV Among Homeless Persons in Los Angeles

Authors: Daniel Fuster, Lillian Gelberg

Published in: Journal of Community Health | Issue 6/2019

Abstract

People experiencing homelessness are disproportionally affected by drug and alcohol use and by their serious health consequences. In this study, 137 adults from the “UCLA/ARG/RAND Homeless Hepatitis Study” who were sampled from shelters and meal programs in the Skid Row of Los Angeles and screened for HIV or HCV or HBV infection. Those who tested positive for these infections were counseled about their infections and referred to primary care. They were followed-up at 1 month with interviews to identify rates, and predictors, of seeking primary care. Participants were 87.5% male, mean age of 48.6 years (SD: 8.2); most were Black (77.4%) and were chronically homeless (> 12 months). A majority (70%) had a regular source of care; 78% were lifetime marijuana users, 56% were lifetime cocaine users and 51% had injected intravenously during the past year. Among this sample, 118 participants (86.1%) tested seropositive for HCV infection, 79 (57.7%) HBV infection and 18 (13.1%) HIV infection. At 1-month follow-up, 102 participants (74.5%) attended the clinic they were referred to. The only variable associated with attending the clinic was having slept in a shelter during the previous night versus other sleeping conditions [Odds ratio (95% CI): 3 .0 (1.07–8.42), p = 0.03]. This model offers a simple and efficacious approach to seeking, testing, counseling, and referral to treatment of community-based adults experiencing homelessness with HIV, HCV and/or HBV infection and linking them to primary care. Being sheltered may be the key facilitator for homeless seeking primary care.

Henry M, Watt R, Rosenthal L, Azim S, Associates A. (2017). The 2017 Annual Homeless Assessment Report (AHAR) to Congress. https://www.hudexchange.info/resources/documents/2017-ahar-part-1.pdf.

Hibbs, J. R., Benner, L., Klugman, L., et al. (1994). Mortality in a Cohort of Homeless Adults in Philadelphia. New England Journal of Medicine, 331(5), 304–309. https://doi.org/10.1056/NEJM199408043310506.CrossRefPubMed

Nielsen, S. F., Hjorthøj, C. R., Erlangsen, A., & Nordentoft, M. (2011). Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. Lancet (London, England), 377(9784), 2205–2214. https://doi.org/10.1016/S0140-6736(11)60747-2.CrossRef

Gelberg, L., Robertson, M. J., Arangua, L., et al. (2012). Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in Los Angeles. Public Health Reports, 127(4), 407–421. https://doi.org/10.1177/003335491212700409.CrossRefPubMedPubMedCentral

Strehlow, A. J., Robertson, M. J., Zerger, S., et al. (2012). Hepatitis C among clients of health care for the homeless primary care clinics. Journal of Health Care for the Poor and Underserved, 23(2), 811–833. https://doi.org/10.1353/hpu.2012.0047.CrossRefPubMedPubMedCentral

Craine, N., Hickman, M., Parry, J. V., et al. (2009). Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size. Epidemiology and Infection, 137(09), 1255. https://doi.org/10.1017/S095026880900212X.CrossRefPubMed

Hwang, S. W., & Burns, T. (2014). Health interventions for people who are homeless. Lancet (London, England), 384(9953), 1541–1547. https://doi.org/10.1016/S0140-6736(14)61133-8.CrossRef

Shortt, S. E. D., Hwang, S., Stuart, H., Bedore, M., Zurba, N., & Darling, M. (2008). Delivering primary care to homeless persons: A policy analysis approach to evaluating the options. Health Policy, 4(1), 108–122.

Wen, C. K., Hudak, P. L., & Hwang, S. W. (2007). Homeless people’s perceptions of welcomeness and unwelcomeness in healthcare encounters. Journal of General Internal Medicine, 22(7), 1011–1017. https://doi.org/10.1007/s11606-007-0183-7.CrossRefPubMedPubMedCentral

10.

Martins, D. C. (2008). Experiences of homeless people in the health care delivery system: A descriptive phenomenological study. Public Health Nursing, 25(5), 420–430. https://doi.org/10.1111/j.1525-1446.2008.00726.x.CrossRefPubMed

11.

Kertesz, S. G., Holt, C. L., Steward, J. L., et al. (2013). Comparing homeless persons’ care experiences in tailored versus nontailored primary care programs. American Journal of Public Health, 103(S2), S331–S339. https://doi.org/10.2105/AJPH.2013.301481.CrossRefPubMedPubMedCentral

12.

Thompson, V. V., Ragland, K. E., Hall, C. S., Morgan, M., & Bangsberg, D. R. (2005). Provider assessment of eligibility for hepatitis C treatment in HIV-infected homeless and marginally housed persons. AIDS., 19(Suppl 3), S208–S214.CrossRef

13.

Noska, A. J., Belperio, P. S., Loomis, T. P., O’Toole, T. P., & Backus, L. I. (2017). Engagement in the Hepatitis C care cascade among homeless veterans, 2015. Public Health Reports, 132(2), 136–139. https://doi.org/10.1177/0033354916689610.CrossRefPubMedPubMedCentral

14.

Mehta, S. H., Genberg, B. L., Astemborski, J., et al. (2008). Limited uptake of hepatitis C treatment among injection drug users. Journal of Community Health, 33(3), 126–133. https://doi.org/10.1007/s10900-007-9083-3.CrossRefPubMedPubMedCentral

15.

Grebely, J., Haire, B., Taylor, L. E., et al. (2015). Excluding people who use drugs or alcohol from access to hepatitis C treatments—is this fair, given the available data? Journal of Hepatology, 63(4), 779–782. https://doi.org/10.1016/j.jhep.2015.06.014.CrossRefPubMedPubMedCentral

16.

Grebely, J., Alavi, M., Micallef, M., et al. (2016). Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: The ETHOS Study. Addiction, 111(2), 311–319. https://doi.org/10.1111/add.13197.CrossRefPubMed

17.

Arora, S., Thornton, K., Murata, G., et al. (2011). Outcomes of treatment for Hepatitis C virus infection by primary care providers. New England Journal of Medicine, 364(23), 2199–2207. https://doi.org/10.1056/NEJMoa1009370.CrossRefPubMed

18.

Group RSR. (2004). RAND Survey Research Group. Downtown Health Project Hepatitis Summary Study Report. Santa Monica: Group RSR.

19.

McKinney-Vento. (1987). Homeless Assistance Act. Public Law, pp. 100–177.

20.

Manly, J. J., Bell-McGinty, S., Tang, M.-X., Schupf, N., Stern, Y., & Mayeux, R. (2005). Implementing diagnostic criteria and estimating frequency of mild cognitive impairment in an Urban community. Archives of Neurology, 62(11), 1739. https://doi.org/10.1001/archneur.62.11.1739.CrossRefPubMed

21.

Robertson, M. J., Zlotnick, C., & Westerfelt, A. (1997). Drug use disorders and treatment contact among homeless adults in Alameda County California. American Journal of Public Health, 87(2), 221–228.CrossRef

22.

Vernez, G., Burnam, M. A., McGlynn, E., Trude, S., & Mattman, B. (1988). Review of California’s program for the homeless mentally disabled. Santa Monica: The RAND Corp.

23.

Armstrong, G. L., Wasley, A., Simard, E. P., McQuillan, G. M., Kuhnert, W. L., & Alter, M. J. (2006). The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Annals of Internal Medicine, 144(10), 705–714.CrossRef

24.

Robertson, M. J., Clark, R. A., Charlebois, E. D., et al. (2004). HIV seroprevalence among homeless and marginally housed adults in San Francisco. American Journal of Public Health, 94(7), 1207–1217.CrossRef

25.

Kral, A. H., Bluthenthal, R. N., Booth, R. E., & Watters, J. K. (1998). HIV seroprevalence among street-recruited injection drug and crack cocaine users in 16 US municipalities. American Journal of Public Health, 88(1), 108–113.CrossRef

26.

Des Jarlais, D. C., Hagan, H., Arasteh, K., McKnight, C., Semaan, S., & Perlman, D. C. (2011). Can intranasal drug use reduce HCV infection among injecting drug users? Drug and Alcohol Dependence, 119(3), 201–206. https://doi.org/10.1016/j.drugalcdep.2011.06.020.CrossRefPubMedPubMedCentral

27.

Baggett, T. P., Hwang, S. W., O’Connell, J. J., et al. (2013). Mortality among homeless adults in boston. JAMA Internal Medicine, 173(3), 189. https://doi.org/10.1001/jamainternmed.2013.1604.CrossRefPubMedPubMedCentral

28.

Elwell-Sutton, T., Fok, J., Albanese, F., Mathie, H., & Holland, R. (2016). Factors associated with access to care and healthcare utilization in the homeless population of England. Journal of Public Health (Bangkok), 39(1), 008.

29.

Vagenas, P., Azar, M. M., Copenhaver, M. M., Springer, S. A., Molina, P. E., & Altice, F. L. (2015). The impact of alcohol use and related disorders on the HIV continuum of care: A systematic review: Alcohol and the HIV continuum of care. Current HIV/AIDS Reports, 12(4), 421–436. https://doi.org/10.1007/s11904-015-0285-5.CrossRefPubMedPubMedCentral

30.

Fuster, D., Sanvisens, A., Bolao, F., Rivas, I., Tor, J., & Muga, R. (2016). Alcohol use disorder and its impact on chronic hepatitis C virus and human immunodeficiency virus infections. World Journal of Hepatology, 8(31), 1295–1308. https://doi.org/10.4254/wjh.v8.i31.1295.CrossRefPubMedPubMedCentral

31.

Walley, A. Y., Palmisano, J., Sorensen-Alawad, A., et al. (2015). Engagement and substance dependence in a primary care-based addiction treatment program for people infected with HIV and people at high-risk for HIV infection. Journal of Substance Abuse Treatment, 59, 59–66. https://doi.org/10.1016/j.jsat.2015.07.007.CrossRefPubMed

32.

Ho, C. J., Preston, C., Fredericks, K., et al. (2013). A unique model for treating chronic hepatitis C in patients with psychiatric disorders, substance abuse, and/or housing instability. Journal of Addiction Medicine, 7(5), 320–324. https://doi.org/10.1097/ADM.0b013e31829b1a6c.CrossRefPubMed

33.

Rendon, A., Livingston, M., Suzuki, S., Hill, W., & Walters, S. (2017). What’s the agreement between self-reported and biochemical verification of drug use? A look at permanent supportive housing residents. Addictive Behaviors, 70, 90–96. https://doi.org/10.1016/j.addbeh.2017.02.011.CrossRefPubMed

34.

Schumacher, J. E., Milby, J. B., Raczynski, J. M., et al. (1995). Validity of self-reported crack cocaine use among homeless persons in treatment. Journal of Substance Abuse Treatment, 12(5), 335–339.CrossRef

35.

Afdhal, N. H., Zeuzem, S., Schooley, R. T., et al. (2013). The new paradigm of hepatitis C therapy: Integration of oral therapies into best practices. Journal of Viral Hepatatis, 20(11), 745–760. https://doi.org/10.1111/jvh.12173.CrossRef

Title: Community Screening, Identification, and Referral to Primary Care, for Hepatitis C, B, and HIV Among Homeless Persons in Los Angeles
Authors: Daniel Fuster
Lillian Gelberg
Publication date: 01-12-2019
Publisher: Springer US
Keywords: Hepatitis B
Care
Human Immunodeficiency Virus
Hepatitis C
Published in: Journal of Community Health / Issue 6/2019
Print ISSN: 0094-5145
Electronic ISSN: 1573-3610
DOI: https://doi.org/10.1007/s10900-019-00679-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Community Screening, Identification, and Referral to Primary Care, for Hepatitis C, B, and HIV Among Homeless Persons in Los Angeles

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2019

Contraception, HIV Services, and PrEP in South African Hair Salons: A Qualitative Study of Owner, Stylist, and Client Perspectives

Barriers to Pap Smear Among Homeless Women at Albuquerque Healthcare for the Homeless

Perceptions of Pediatric Primary Care Among Mothers in Treatment for Opioid Use Disorder

Perceptions of Smoking and Vaping on Weight Control Among Adult American Indians Who Smoke

Prevalence of Indoor Tanning Among U.S. High School Students from 2009 to 2017

Evaluation of a Pilot Intervention to Reduce Mental Health and Addiction Stigma in Primary Care Settings