title: Social determinants of health associated with hepatitis C co-infection among people living with HIV: results from the Positive Spaces, Healthy Places study.
abstract: BACKGROUND
  Social determinants of health (SDOH) may influence the probability of people living with HIV also being infected with hepatitis C virus (HCV). We compared the SDOH of adults co-infected with HCV/HIV with that of HIV mono-infected adults to identify factors independently associated with HCV infection.
  
  
  METHODS
  In this cross-sectional study, face-to-face interviews were conducted with 509 HIV-infected adults affiliated with or receiving services from community-based AIDS service organizations (CBAOs). The primary outcome measure was self-reported HCV infection status. Chi-square, Student's t tests, and Wilcoxon rank-sum tests were performed to compare SDOH of HCV/HIV co-infected participants with that of HIV mono-infected participants. Multivariable hierarchical logistic regression was used to identify factors independently associated with HCV co-infection.
  
  
  RESULTS
  Data on 482 (95 HCV/HIV co-infected and 387 HIV mono-infected) adults were analyzed. Compared with participants infected with HIV only, those who were co-infected with HIV and HCV were more likely to be heterosexual, Aboriginal, less educated and unemployed. They were more likely to have a low income, to not be receiving antiretroviral treatment, to live outside the Greater Toronto Area (GTA), to use/abuse substances, experience significant depression, and utilize addiction counselling and needle-exchange services. They also were more likely to report a history of homelessness and perceived housing-related discrimination and to have moved twice or more in the previous 12 months. Factors independently associated with HCV/HIV co-infection were history of incarceration (odds ratio [OR] 8.81, 95% CI 4.43-17.54), history of homelessness (OR 3.15, 95% CI 1.59-6.26), living outside of the GTA (OR 3.13, 95% CI 1.59-6.15), and using/abusing substances in the past 12 months (OR 2.05, 95% CI 1.07-3.91).
  
  
  CONCLUSIONS
  Differences in SDOH exist between HIV/HCV co-infected and HIV mono-infected adults. History of incarceration, history of homelessness, substance use, and living outside the GTA were independently associated with HCV/HIV co-infection. Interventions that reduce homelessness and incarceration may help prevent HCV infection in people living with HIV.
authors: Ontario HIV Treatment Network, Canada.
authors: Sean B
authors: SB
authors: Rourke
authors: Michael
authors: M
authors: Sobota
authors: Ruthann
authors: R
authors: Tucker
authors: Tsegaye
authors: T
authors: Bekele
authors: Katherine
authors: K
authors: Gibson
authors: Saara
authors: S
authors: Greene
authors: Colleen
authors: C
authors: Price
authors: J J Jay
authors: JJ
authors: Koornstra
authors: Laverne
authors: L
authors: Monette
authors: Steve
authors: S
authors: Byers
authors: James
authors: J
authors: Watson
authors: Stephen W
authors: SW
authors: Hwang
authors: Dale
authors: D
authors: Guenter
authors: James
authors: J
authors: Dunn
authors: Amrita
authors: A
authors: Ahluwalia
authors: Michael G
authors: MG
authors: Wilson
authors: Jean
authors: J
authors: Bacon
mesh_terms: D000328:Adult; D015897:Comorbidity; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis; D015981:Epidemiologic Factors; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology; D006296:Health Services / Q000706:statistics & numerical data; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006526:Hepatitis C / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology; D006703:Ill-Housed Persons; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D012111:Residence Characteristics; D012307:Risk Factors; D057566:Self Report; D012931:Social Environment