Prevalence and risk factors of viral hepatitis and HIV among people experiencing homelessness in Germany based on a nationwide study

Abstract

Abstract People experiencing homelessness (PEH) are at risk of contracting and transmitting infectious diseases. Data on PEH blood-transmitted virus prevalence and vaccination coverage is needed to design targeted interventions. A nationwide multicentre cross-sectional study of PEH was conducted. Clinical data were collected through questionnaire-based interviews, and blood samples were tested by serology and qPCR. Latent class analysis (LCA) identified subgroups of PEH, while univariable regressions identified risk factors of viral hepatitis. 643 PEH from four metropolitan areas in Germany were included. LCA revealed national short-term, long-term and international short-term PEH subgroups. The prevalence of anti-HAV-IgG, anti-HBc, anti-HBsAg, anti-HCV, anti-HEV and anti-HIV was 44% (95%CI: 39–48%), 17% (95%CI: 14–21%), 25% (95%CI: 21–29%), 18% (95%CI: 15–22%), 29% (95%CI: 25–33%) and 0.7% (95%CI: 0.2–1.7%), respectively. Active HBV and HCV infection was detected in 1.4% (95%CI: 0.7–2.7%) and 12% (95%CI: 9.6–14%), respectively. Univariable logistic regression revealed PEH with former imprisonment had 13.24 times the odds of active or past HCV infection (95%CI: 6.28–27.90) that individuals without had. This study shows the high acquisition and transmission risks for HCV/HIV among PEH. Low vaccination coverage for HAV/HBV calls for revising vaccine recommendations. High HCV infection risk associated with imprisonment highlights the need to address health disparities faced by incarcerated individuals.