A220 THE EFFECT OF HOMELESSNESS ON HCV TREATMENT OUTCOMES AMONG PEOPLE WHO INJECT DRUGS

Recent European guidelines have identified people who inject drugs (PWID) as a priority population to receive HCV treatment. Achievement and maintenance of a sustained virologic response (SVR) may be influenced by a number of factors, including the social determinants of health in such vulnerable populations. One such variable may be unstable housing. We sought to evaluate the impact of homelessness on the achievement and maintenance of SVR in both HCV mono-infected and hepatitis C/human immunodeficiency virus (HCV/HIV) co-infected PWID receiving HCV therapy at a tertiary clinic located in downtown Vancouver. The target population consisted of HCV-infected PWID receiving HCV therapy according to contemporary clinical guidelines within the multidisciplinary program at the Vancouver Infectious Diseases Center (VIDC), providing care to address medical, psychological, social and addiction-related needs. Demographic information was collected including patters of recreational drug use. Self-declared homelessness was ascertained by a self-administered questionnaire. The initial endpoint of the study was achievement and maintenance of SVR, with patients followed every 6 months after SVR, more frequently in the setting of suspected HCV re-infection, with such re-infection post-SVR considered a failure of treatment. The study population included 38 individuals of whom 7 (12.5%) women, 20 (53%) HIV co-infected, 24 (63%) genotype 1, 20 (53%), on opiate substitution therapy, with mixed patterns of recreational drug use (39% opiates, 17% cocaine, 47% amphetamines). Homelessness was present in 38 (100%). The crude SVR rate was 79% (30/38), higher in HCV mono-infected individuals (89% vs. 70%). In addition, 2 cases of HCV re-infection were documented, all among HIV co-infected individuals, leading to an effective SVR rate of 60% in this sub-group. Overall, homelessness was associated with a 30% increase in risk of not achieving and maintaining SVR. Type of recreational drug use (opiates vs. stimulants) was not associated with the likelihood of HCV treatment success. High rates of response to HCV treatment can be achieved and maintained among active PWID. However, in this vulnerable population, attention must be paid to non-traditional factors that may influence outcomes, including homelessness, especially among those who are co-infected with HIV. As more PWID are offered HCV therapy, programs must be developed to address short and long-term housing to maximize the impact of these interventions. None

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