1071. Social Determinants of health (SDOH) among PWID living with HCV

Abstract

Background. Though people who inject drugs (PWID) represent the overwhelming majority of those living with HCV, most have not been treated. Many HCV+ PWID represent the most marginalized persons in society, often experiencing poverty and poor access to care. We set out to determine the social determinants of health (SDOH) among a population of HCV+ PWID and determine if poor SDOH were related to reduced HCV treatment uptake. Methods. The HCV-GET UP study was a randomized controlled trial to assess the effectiveness of an HCV group evaluation intervention vs. individual HCV treatment among PWID within a primary care clinic in the Bronx, NY. HCV treatment was provided according to national guidelines. Here, we include all patient characteristics and baseline social determinants of health (SDOH), obtained through questionnaires using Audio Computer-Assisted Self-Interview (ACASI) technology. We performed bivariate analyses between treatment initiation and the various factors of the SDOH using chi square tests. Results. The majority of the 84 participants enrolled were black (35%) or Hispanic (60%) males (77%), aged 51 (SD11). The majority are on NY State Medicaid insurance (68%), indicating that their income is less than 138% of the Federal Poverty Level. 42% of participants report running out of money for basic needs on a daily or weekly basis, 69% receive food stamps, and 23% are homeless. Nearly half (45%) of participants have less than a high school education, 57% have ever been incarcerated, 48% report not having transportation to get to a medical appointment, and 25% do not trust doctors. A total of 57% of participants initiated HCV treatment, and no factors of SDOH were associated with treatment initiation. Conclusion. We found that HCV+ PWID have extremely poor SDOH. Despite this, over half of participants initiated HCV treatment, indicating participants willingness to receive HCV treatment, and resilience in overcoming SDOH. Poor SDOH, such as homelessness, should not be a reason to delay HCV treatment in this population; however, we risk severely muting the health benefits of HCV cure in this population, if we do not address the underlying SDOH that will certainly lead to poor health outcomes, and early death.