A220 THE EFFECT OF HOMELESSNESS ON HCV TREATMENT OUTCOMES AMONG PEOPLE WHO INJECT DRUGS

Abstract

Background: Recent European guidelines have identified people who inject drugs (PWID) as a priority population to receive HCV treatment. Achievement and maintenance of a sustained virologic response (SVR) may be influenced by a number of factors, including the social determinants of health in such vulnerable populations. One such variable may be unstable housing. Aims: We sought to evaluate the impact of homelessness on the achievement and maintenance of SVR in both HCV mono-infected and hepatitis C/human immunodeficiency virus (HCV/HIV) co-infected PWID receiving HCV therapy at a tertiary clinic located in downtown Vancouver. Methods: The target population consisted of HCV-infected PWID receiving HCV therapy according to contemporary clinical guidelines within the multidisciplinary program at the Vancouver Infectious Diseases Center (VIDC), providing care to address medical, psychological, social and addiction-related needs. Demographic information was collected including patters of recreational drug use. Self-declared homelessness was ascertained by a self-administered questionnaire. The initial endpoint of the study was achievement and maintenance of SVR, with patients followed every 6 months after SVR, more frequently in the setting of suspected HCV reinfection, with such re-infection post-SVR considered a failure of treatment. Results: The study population included 38 individuals of whom 7 (12.5%) women, 20 (53%) HIV co-infected, 24 (63%) genotype 1, 20 (53%), on opiate substitution therapy, with mixed patterns of recreational drug use (39% opiates, 17% cocaine, 47% amphetamines). Homelessness was present in 38 (100%). The crude SVR rate was 79% (30/38), higher in HCV mono-infected individuals (89% vs. 70%). In addition, 2 cases of HCV re-infection were documented, all among HIV co-infected individuals, leading to an effective SVR rate of 60% in this sub-group. Overall, homelessness was associated with a 30% increase in risk of not achieving and maintaining SVR. Type of recreational drug use (opiates vs. stimulants) was not associated with the likelihood of HCV treatment success. Conclusions: High rates of response to HCV treatment can be achieved and maintained among active PWID. However, in this vulnerable population, attention must be paid to non-traditional factors that may influence outcomes, including homelessness, especially among those who are co-infected with HIV. As more PWID are offered HCV therapy, programs must be developed to address short and long-term housing to maximize the impact of these interventions.