title: Prevalence of Human Immunodeficiency Virus, Hepatitis C Virus, and Hepatitis B Virus Among Homeless and Nonhomeless United States Veterans.
abstract: BACKGROUND
  Veterans are disproportionately affected by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (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.
  
  
  METHODS
  Using data from the Department of Veterans Affairs (VA) Corporate Warehouse Data from 2015, we evaluated HIV, HCV, and HBV laboratory testing and infection confirmation rates and diagnoses on the Problem List for nonhomeless veterans and for veterans utilizing homeless services in 2015.
  
  
  RESULTS
  Among 242740 homeless veterans in VA care in 2015, HIV, HCV, and HBV testing occurred in 63.8% (n = 154812), 78.1% (n = 189508), and 52.8% (n = 128262), respectively. The HIV population prevalence was 1.52% (3684/242740) among homeless veterans, compared with 0.44% (23797/5424685) among nonhomeless veterans. The HCV population prevalence among homeless veterans was 12.1% (29311/242740), compared with 2.7% (148079/5424685) among nonhomeless veterans, while the HBV population prevalence was 0.99% (2395/242740) for homeless veterans and 0.40% (21611/5424685) among nonhomeless veterans.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Providence VA Medical Center, Division of Infectious Diseases, Providence, Rhode Island.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Noska
authors.affiliation: Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, California.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Belperio
authors.affiliation: Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, California.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Loomis
authors.affiliation: National Center on Homelessness Among Veterans, Homeless PACT Program, Veterans Health Administration Homeless Program Office, Providence, Rhode Island.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
authors.affiliation: Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, California.
authors.forename: Lisa I
authors.initials: LI
authors.lastname: Backus
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D016174:Hepacivirus / Q000302:isolation & purification; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006515:Hepatitis B virus / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology* / Q000821:virology; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014728:Veterans
keywords: HIV; hepatitis B; hepatitis C; homeless; veterans