Substance Use
Systematic Review and Meta-Analysis: Hepatitis C Treatment Outcomes by Housing Status Among People Who Inject Drugs Sarah Kimball* Sarah Kimball Marley Reynoso Courtney McKnight Don Des Jarlais
Background
The prevalence of hepatitis C virus (HCV) among people who inject drugs (PWID) is between 50-70%. Prior systematic reviews demonstrated that PWID have similar direct-acting antiviral treatment outcomes compared to non-PWID; however, reviews have not examined treatment outcomes by housing status. Given the links between housing and health, identifying gaps in HCV treatment can guide future interventions.
Methods
We conducted a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched six databases for articles from 2014 onward. Two reviewers conducted title/abstract screenings, full-text review, and data extraction. We extracted effect measures for treatment initiation, adherence, completion, success/cure, and reinfection by housing status. Studies underwent quality and certainty assessments, and we performed meta-analyses as appropriate.
Results
Our search yielded 473 studies, eight met inclusion criteria. Only initiation had sufficient measures for meta-analysis. Using a random-effects model, we found those with unstable housing had 0.40 (0.26, 0.62) times the odds of initiating treatment compared to those with stable housing. Other outcomes were not amenable for meta-analysis due to a limited number of studies or differing outcome definitions.
Conclusions
Among PWID, unstable housing appears to be a barrier to HCV treatment initiation; however, the existing data is limited for initiation and the other outcomes examined. There is a need for more informative studies to better understand HCV treatment among those with unstable housing. In particular, future studies should better define housing status beyond a binary, static measure to capture the nuances and complexity of housing and its subsequent impact on HCV treatment. Additionally, researchers should meaningfully consider how they define outcomes and if they truly measure the outcome of interest for someone experiencing unstable housing.