Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis
Chiedozie Arum, Hannah Fraser, Andreea Adelina Artenie, Sandra Bivegete, Adam Trickey, Michel Alary, Jacquie Astemborski, Jennifer Iversen, Aaron G. Lim, Louis MacGregor, Meghan D. Morris, Jason J. Ong, Lucy Platt, Rachel Sack-Davis, Daniela K van Santen, Sunil S. Solomon, Vana Sypsa, Jorge Valencia, Wijnand van den Boom, Josephine G. Walker, Zoë Ward, Jack Stone, Peter Vickerman, Peter Cherutich, Kora DeBeck, Paul Dietze, Kostyantyn Dumchev, Kanna Hayashi, Margaret Hellard, Matthew Hickman, Vivian Hope, Ali Judd, Martin Kåberg, Ann Kurth, Pascale Leclerc, Lisa Maher, Shruti H. Mehta, Kimberly Page, Maria Prins, Catherine S. Todd, Steffanie A. Strathdee
Abstract
BACKGROUND: People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. METHODS: statistic and p value for heterogeneity. FINDINGS: = 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13-2·95; p=0·014]; n=5) was higher than for homelessness (1·44 [1·13-1·83; p=0·0036]; n=12), whereas no difference was seen between these outcomes for risk of HCV acquisition (1·72 [1·48-1·99; p<0·0001] for unstable housing, 1·66 [1·37-2·00; p<0·0001] for homelessness). INTERPRETATION: Homelessness and unstable housing are associated with increased risk of HIV and HCV acquisition among PWID. Our findings support the development of interventions that simultaneously address homelessness and unstable housing and HIV and HCV transmission in this population. FUNDING: National Institute for Health Research, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, and Commonwealth Scholarship Commission.