Exploring Clinical and Social Variables Associated with Hepatitis C Infection in Homeless Individuals Residing in Travis County, Texas

Victoria Fleming, The University of Texas School of Public Health


Hepatitis C virus (HCV) is a blood-borne virus that predominately affects the liver. Hepatitis C is generally transmitted through sharing contaminated injection needles. Injection drug users (IDU) pose a greater risk of obtaining and spreading hepatitis C infection compared to non-injection drug users. An estimated 3.2 million Americans are currently infected with hepatitis C, with only 1.6% of the general population infected, compared to more than 40% of homeless individuals. Homeless and marginally housed (HMH) populations experience greater barriers to receiving hepatitis C treatment. Social and economic barriers, such as lack of stable housing, transportation, or continual drug use, threaten compliance and sustained virologic response (SVR) attainment. To date, there is not any peer-reviewed literature concerning unique clinical and social variables of hepatitis C infected homeless populations. This study used a retrospective cohort study to assess social and clinical factors in hepatitis C infected homeless individuals in Travis County, TX. Data was obtained using a standardized survey tool, the Vulnerability Index and Service Prioritization Decision Assistance Tool (VI-SPDAT). There were many measurements collected such as demographics, mental health and substance use history, medical comorbidities, socioeconomic factors, and service utilization rates. Logistic regression analysis was used to examine these variables, and in doing so, provided a framework for physicians as they develop hepatitis C treatment plans for patients who are experiencing homelessness. This survey was collected from September of 2014 to August of 2017, with over 5,444 unique individuals completing an initial assessment who identified as homeless and were surveyed to determine priority and eligibility for receiving housing services. Twenty percent of the study population reported a positive hepatitis C infection and those infected were more likely to be non-veteran (OR=0.67, <.0001), white males (OR=1.9, p<.0001; OR=0.80, p=.004). There were several comorbidities that were associated with hepatitis C infection, such as tuberculosis (OR = 2.46, p<.0001) and emphysema (OR=2.03, p<.0001). Those with hepatitis C were more likely to have a history of IDU (OR=3.18, p<.0001) and traumatic brain injury (OR=1.55, p<.0001). Additionally, those positively infected had higher odds of being homeless for longer periods of time (OR=2.45, p<.0001) and had elevated utilization of services, such as number of ambulance trips (OR =1.06, p=.02). The aim of this thesis was to explore differences in those with and without hepatitis C among homeless and marginally-housed populations. Due to the estimated high prevalence of infection among this vulnerable group, more research is needed to understand other behavioral, clinical, and social variables that are associated with those who are positively infected. This thesis adds to the significant gap in research over hepatitis C infection within this cohort by quantifying comorbidities, mental health and substance abuse histories, socioeconomic factors, and other relevant demographic information.

Subject Area

Biology|Public health|Epidemiology

Recommended Citation

Fleming, Victoria, "Exploring Clinical and Social Variables Associated with Hepatitis C Infection in Homeless Individuals Residing in Travis County, Texas" (2018). Texas Medical Center Dissertations (via ProQuest). AAI10790515.