title: Prevalence of Hepatitis C virus infection in a sample of homeless veterans.
abstract: OBJECTIVE
  This study measures the prevalence of Hepatitis C Virus (HCV) infection in a sample of homeless veterans treated in a Domiciliary Care for Homeless Veterans (DCHV) program in Massachusetts. We also examine risk factors and correlates for HCV infection, including substance abuse and service in Vietnam.
  
  
  METHODS
  Patients admitted to the DCHV program over a 5-year period (n=418) were systematically tested for HCV infection. Blood test data were merged with standardized data collection forms to assess socio-demographic characteristics, military history, and medical and psychiatric history.
  
  
  RESULTS
  The overall prevalence rate of HCV infection was 44.02%, a rate more than ten times higher than the national rate for men age 20-59 and more than twice as high as other VA patient samples. Adjusting for age, significant risk factors in this sample included a history of substance abuse (OR=6.86, p<0.0001) and service during the Vietnam era (OR=4.66, p=0.01). Comparisons of the tested sample with other homeless veterans treated in 34 similar programs nationally indicated that this sample did not significantly differ from other treated homeless veterans with respect to demographics or HCV risk factors.
  
  
  CONCLUSIONS
  We found a high prevalence of HCV infection in this population that is not likely to be geographically unique, and may indicate particularly high risk for homeless men. Substance abuse is the most important risk factor, and we hypothesize that the effect of Vietnam-era service is a proxy for unreported drug use. We advise an increase in screening and education for all homeless populations, particularly those with a history of injection drug use. Public systems of care, including the VA, should expect increasing costs of care related to HCV infection as prevalent cases develop serious medical sequelae of HCV infection.
authors.affiliation: Northeast Program Evaluation Center/182, VA Connecticut Healthcare System, Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA.
authors.forename: Rani A
authors.initials: RA
authors.lastname: Desai
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
authors.forename: Vincent
authors.initials: V
authors.lastname: Agnello
mesh_terms: D000328:Adult; D017677:Age Distribution; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012494:Sampling Studies; D017678:Sex Distribution; D014728:Veterans / Q000706:statistics & numerical data*