Viral blood-borne infections testing and linkage to care cascade among persons who experience homelessness in the United States: a systematic review and meta-analysis
| Autor: | Ria Saha, Amanda P. Miller, Andrea Parriott, Hacsi Horvath, James G. Kahn, Mohsen Malekinejad |
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| Rok vydání: | 2022 |
| Předmět: |
Hepatitis B virus
Drug Abuse (NIDA Only) Chronic Liver Disease and Cirrhosis HIV Infections Hepacivirus Hepatitis Hepatitis - B Targeted testing Hepatitis - C Viral blood-borne infections HBV Humans Blood-Borne Infections Liver Disease Prevention Public Health Environmental and Occupational Health Substance Abuse HIV Homeless Persons Care cascade Hepatitis B Hepatitis C United States Persons who experience homelessness Infectious Diseases Emerging Infectious Diseases Good Health and Well Being HCV Ill-Housed Persons Public Health and Health Services HIV/AIDS Public Health Digestive Diseases Infection |
| Zdroj: | BMC public health, vol 22, iss 1 |
| Popis: | BackgroundPersons who experience homelessness remain at increased risk for three viral blood-borne infections: human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). We assessed the yield of testing and linkage to care programs targeting this population for these infections in the United States (US).MethodsWe searched PubMed, Embase, Web of Science, and Cochrane Central for peer-reviewed articles through August 27, 2020. Additionally, we searched the grey literature. Two individuals independently reviewed all relevant studies to check for eligibility and extracted data for each step in the care cascade. We used random-effects model to generate weighted pooled proportions to assess yield at each step. Cumulative proportions were calculated as products of adjacent-step pooled proportions. We quantitatively synthesized data from the studies that focused on non-drug injecting individuals.ResultsWe identified 24 studies published between 1996–2019 conducted in 19 US states. Seventeen studies screened for HIV, 12 for HCV, and two screened for HBV. For HIV, 72% of approached were recruited, 64% had valid results, 4% tested positive, 2% were given results, and 1% were referred and attended follow-up. Of positives, 25% were referred to treatment and started care. For HCV, 69% of approached were recruited, 63% had valid results, 16% tested positive, 14% were given results, and 3% attended follow-up. Of positives, 30% were referred for treatment and 19% started care. The yield at each care cascade step differs widely by recruitment strategy (for example, for HIV: 71.6% recruited of reached under service-based with zero yield under healthcare facility-based and outreach).ConclusionsA very large proportion of this population reached for HIV and HCV care were lost in the follow-up steps and never received treatment. Future programs should examine drop-out reasons and intervene to reduce health disparities in this population. |
| Databáze: | OpenAIRE |
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