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Prevalence of HIV, HCV and HBV among Homeless
and Non-homeless United States Veterans
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CID March 2017
Amanda J. Noska1, Pamela S. Belperio2, Timothy P. Loomis2, Thomas P. O'Toole3, Lisa I. Backus2 1 Providence VA Medical Center, Division of Infectious Diseases, 830 Chalkstone Ave Providence, RI, USA 2Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA, USA 3 National Center on Homelessness among Veterans, Homeless PACT Program, VHA Homeless Program Office, 830 Chalkstone Ave, Providence, RI, USA

Veterans are disproportionately affected by HIV, hepatitis C (HCV) and hepatitis B (HBV). Homeless veterans are at particularly high risk for HIV, HCV and HBV due to a variety of overlapping risk factors, including high rates of mental health disorders and substance use disorders. The prevalence of HIV, HCV and HBV among homeless veterans nationally is currently unknown. This study describes national testing rates and prevalence of HIV, HCV and HBV among homeless veterans.
Using data from the VA's Corporate Warehouse Data from 2015, we evaluated HIV, HCV, and HBV laboratory testing and infection confirmation rates and diagnoses on the Problem List for non-homeless veterans and for veterans utilizing homeless services in 2015.
Among 242,740 homeless veterans in VA care in 2015, HIV, HCV and HBV testing occurred in 63.8% (n=154,812), 78.1% (n=189,508), and 52.8% (n=128,262), respectively. The HIV population prevalence was 1.52% (3,684/242,740) among homeless veterans, compared to 0.44% (23,797/5,424,685) among non-homeless veterans. The HCV population prevalence among homeless veterans was 12.1% (29,311/242,740), compared to 2.7% (148,079/5,424,685) among non-homeless veterans, while the HBV population prevalence was 0.99% (2,395/242,740) for homeless veterans, and 0.40% (21,611/5,424,685) among non-homeless veterans.
The HCV tested prevalence among homeless veterans compared to non-homeless veterans was 15.3% compared to 4.5%, and the population prevalence was 12.1% compared to 2.7%, respectively. HCV tested and population prevalence of HCV, similar to HIV, was 3.1 and 3.4 times, respectively higher among homeless males than among homeless females.
The HIV/HCV co-infection tested prevalence among homeless veterans was three times higher and the population prevalence nearly six times higher than among non-homeless veterans, respectively.
To our knowledge this work represents the most comprehensive tested prevalence and population prevalence estimates of HIV, HCV and HBV among homeless veterans nationally. The data demonstrate high prevalence of HIV, HCV and HBV among homeless veterans, and reinforce the need for integrated healthcare services along with homeless programming.
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