The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

Jack Stone; Adelina Artenie; Matt  Hickman; Natasha Martin; L Degenhardt; Hannah Fraser; Peter T Vickerman

doi:10.1016/S2468-2667(21)00258-9

The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

Jack Stone^*
, Adelina Artenie
, Matt Hickman
, Natasha Martin
, L Degenhardt
, Hannah Fraser
, Peter T Vickerman

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

35 Citations (Scopus)

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Abstract

Background: People who inject drugs (PWID) experience considerable unstable housing. Although unstable housing is associated with HIV and HCV infection among PWID, its contribution to transmission is unknown.

Methods: We developed country-level models of unstable housing and HIV/HCV transmission among PWID, calibrated to country-specific data on the prevalences of HIV/HCV and unstable housing. Based on our recently published systematic review, unstably housed PWID were assumed to have a 39% (95%CI: 6-84) and 64% (95%CI: 43-89%) increased risk of HIV and HCV transmission, respectively. Models estimated the population attributable fraction (PAF) of unstable housing to HIV and HCV transmission among PWID, defined as the percentage of infections prevented over 2020-2029 if the additional risk due to unstable housing was removed.

Findings: Models were produced for 58 countries with sufficient data (>66% of global PWID population). Globally, we project unstable housing contributes 7.9% (95% credibility interval [CrI] 2.3-15.7) and 11.2% (7.7-15.5) of new HIV and HCV infections among PWID over 2020-2029, respectively. Country-level PAFs were strongly associated with the prevalence of unstable housing. PAFs were greater in high-income countries (HIV:17.2%, 95%CrI:5.1-30.0; HCV:19.4%, 95%CrI:13.8-26.0) than in low or middle-income countries (HIV:6.6%, 95%CrI:1.8-13.1; HCV:8.3%, 95%CrI:5.5-11.7). PAFs were highest in Afghanistan, Czech Republic, India, USA, England and Wales where unstable housing contributed >20% of new HIV and HCV infections.

Interpretation: Unstable housing is an important modifiable risk factor for HIV/HCV transmission among PWID in many countries; emphasising the importance of implementing initiatives to mitigate the risks and reduce housing instability.

Funding: NIHR, NIAID/NIDA

Original language	English
Pages (from-to)	e136-e145
Number of pages	10
Journal	Lancet Public Health
Volume	7
Issue number	2
Early online date	7 Jan 2022
DOIs	https://doi.org/10.1016/S2468-2667(21)00258-9
Publication status	Published - 1 Feb 2022

Bibliographical note

Funding Information:
The study was funded by the US National Institute of Allergy and Infectious Diseases (NIAID) and National Institute for Drug Abuse (NIDA; R01AI147490). JS, MH, PV, and HF acknowledge support from the National Institute of Health (NIH) Research Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol. JS and PV acknowledge funding from NIDA (R01DA033679, R21 DA047902). AA is supported through postdoctoral fellowships through the Canadian Institute of Health Research, Fonds de recherche du Québec – Santé and Canadian Network on Hepatitis C. LD is supported by a National Health and Medical Research Council Senior Principal Research Fellowship (1135991) and a US NIH NIDA grant (R01DA1104470).

Funding Information:
The study was funded by the US National Institute of Allergy and Infectious Diseases (NIAID) and National Institute for Drug Abuse (NIDA; R01AI147490). JS, MH, PV, and HF acknowledge support from the National Institute of Health (NIH) Research Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol. JS and PV acknowledge funding from NIDA (R01DA033679, R21 DA047902). AA is supported through postdoctoral fellowships through the Canadian Institute of Health Research, Fonds de recherche du Qu?bec ? Sant? and Canadian Network on Hepatitis C. LD is supported by a National Health and Medical Research Council Senior Principal Research Fellowship (1135991) and a US NIH NIDA grant (R01DA1104470). Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.

Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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title = "The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study",

abstract = "Background: People who inject drugs (PWID) experience considerable unstable housing. Although unstable housing is associated with HIV and HCV infection among PWID, its contribution to transmission is unknown. Methods: We developed country-level models of unstable housing and HIV/HCV transmission among PWID, calibrated to country-specific data on the prevalences of HIV/HCV and unstable housing. Based on our recently published systematic review, unstably housed PWID were assumed to have a 39\% (95\%CI: 6-84) and 64\% (95\%CI: 43-89\%) increased risk of HIV and HCV transmission, respectively. Models estimated the population attributable fraction (PAF) of unstable housing to HIV and HCV transmission among PWID, defined as the percentage of infections prevented over 2020-2029 if the additional risk due to unstable housing was removed. Findings: Models were produced for 58 countries with sufficient data (>66\% of global PWID population). Globally, we project unstable housing contributes 7.9\% (95\% credibility interval [CrI] 2.3-15.7) and 11.2\% (7.7-15.5) of new HIV and HCV infections among PWID over 2020-2029, respectively. Country-level PAFs were strongly associated with the prevalence of unstable housing. PAFs were greater in high-income countries (HIV:17.2\%, 95\%CrI:5.1-30.0; HCV:19.4\%, 95\%CrI:13.8-26.0) than in low or middle-income countries (HIV:6.6\%, 95\%CrI:1.8-13.1; HCV:8.3\%, 95\%CrI:5.5-11.7). PAFs were highest in Afghanistan, Czech Republic, India, USA, England and Wales where unstable housing contributed >20\% of new HIV and HCV infections. Interpretation: Unstable housing is an important modifiable risk factor for HIV/HCV transmission among PWID in many countries; emphasising the importance of implementing initiatives to mitigate the risks and reduce housing instability. Funding: NIHR, NIAID/NIDA",

author = "Jack Stone and Adelina Artenie and Matt Hickman and Natasha Martin and L Degenhardt and Hannah Fraser and Vickerman, \{Peter T\}",

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The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study. / Stone, Jack ; Artenie, Adelina ; Hickman, Matt et al.
In: Lancet Public Health, Vol. 7, No. 2, 01.02.2022, p. e136-e145.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level

T2 - a modelling study

AU - Stone, Jack

AU - Artenie, Adelina

AU - Hickman, Matt

AU - Martin, Natasha

AU - Degenhardt, L

AU - Fraser, Hannah

AU - Vickerman, Peter T

N1 - Funding Information: The study was funded by the US National Institute of Allergy and Infectious Diseases (NIAID) and National Institute for Drug Abuse (NIDA; R01AI147490). JS, MH, PV, and HF acknowledge support from the National Institute of Health (NIH) Research Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol. JS and PV acknowledge funding from NIDA (R01DA033679, R21 DA047902). AA is supported through postdoctoral fellowships through the Canadian Institute of Health Research, Fonds de recherche du Québec – Santé and Canadian Network on Hepatitis C. LD is supported by a National Health and Medical Research Council Senior Principal Research Fellowship (1135991) and a US NIH NIDA grant (R01DA1104470). Funding Information: The study was funded by the US National Institute of Allergy and Infectious Diseases (NIAID) and National Institute for Drug Abuse (NIDA; R01AI147490). JS, MH, PV, and HF acknowledge support from the National Institute of Health (NIH) Research Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol. JS and PV acknowledge funding from NIDA (R01DA033679, R21 DA047902). AA is supported through postdoctoral fellowships through the Canadian Institute of Health Research, Fonds de recherche du Qu?bec ? Sant? and Canadian Network on Hepatitis C. LD is supported by a National Health and Medical Research Council Senior Principal Research Fellowship (1135991) and a US NIH NIDA grant (R01DA1104470). Editorial note: the Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations. Publisher Copyright: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

PY - 2022/2/1

Y1 - 2022/2/1

N2 - Background: People who inject drugs (PWID) experience considerable unstable housing. Although unstable housing is associated with HIV and HCV infection among PWID, its contribution to transmission is unknown. Methods: We developed country-level models of unstable housing and HIV/HCV transmission among PWID, calibrated to country-specific data on the prevalences of HIV/HCV and unstable housing. Based on our recently published systematic review, unstably housed PWID were assumed to have a 39% (95%CI: 6-84) and 64% (95%CI: 43-89%) increased risk of HIV and HCV transmission, respectively. Models estimated the population attributable fraction (PAF) of unstable housing to HIV and HCV transmission among PWID, defined as the percentage of infections prevented over 2020-2029 if the additional risk due to unstable housing was removed. Findings: Models were produced for 58 countries with sufficient data (>66% of global PWID population). Globally, we project unstable housing contributes 7.9% (95% credibility interval [CrI] 2.3-15.7) and 11.2% (7.7-15.5) of new HIV and HCV infections among PWID over 2020-2029, respectively. Country-level PAFs were strongly associated with the prevalence of unstable housing. PAFs were greater in high-income countries (HIV:17.2%, 95%CrI:5.1-30.0; HCV:19.4%, 95%CrI:13.8-26.0) than in low or middle-income countries (HIV:6.6%, 95%CrI:1.8-13.1; HCV:8.3%, 95%CrI:5.5-11.7). PAFs were highest in Afghanistan, Czech Republic, India, USA, England and Wales where unstable housing contributed >20% of new HIV and HCV infections. Interpretation: Unstable housing is an important modifiable risk factor for HIV/HCV transmission among PWID in many countries; emphasising the importance of implementing initiatives to mitigate the risks and reduce housing instability. Funding: NIHR, NIAID/NIDA

AB - Background: People who inject drugs (PWID) experience considerable unstable housing. Although unstable housing is associated with HIV and HCV infection among PWID, its contribution to transmission is unknown. Methods: We developed country-level models of unstable housing and HIV/HCV transmission among PWID, calibrated to country-specific data on the prevalences of HIV/HCV and unstable housing. Based on our recently published systematic review, unstably housed PWID were assumed to have a 39% (95%CI: 6-84) and 64% (95%CI: 43-89%) increased risk of HIV and HCV transmission, respectively. Models estimated the population attributable fraction (PAF) of unstable housing to HIV and HCV transmission among PWID, defined as the percentage of infections prevented over 2020-2029 if the additional risk due to unstable housing was removed. Findings: Models were produced for 58 countries with sufficient data (>66% of global PWID population). Globally, we project unstable housing contributes 7.9% (95% credibility interval [CrI] 2.3-15.7) and 11.2% (7.7-15.5) of new HIV and HCV infections among PWID over 2020-2029, respectively. Country-level PAFs were strongly associated with the prevalence of unstable housing. PAFs were greater in high-income countries (HIV:17.2%, 95%CrI:5.1-30.0; HCV:19.4%, 95%CrI:13.8-26.0) than in low or middle-income countries (HIV:6.6%, 95%CrI:1.8-13.1; HCV:8.3%, 95%CrI:5.5-11.7). PAFs were highest in Afghanistan, Czech Republic, India, USA, England and Wales where unstable housing contributed >20% of new HIV and HCV infections. Interpretation: Unstable housing is an important modifiable risk factor for HIV/HCV transmission among PWID in many countries; emphasising the importance of implementing initiatives to mitigate the risks and reduce housing instability. Funding: NIHR, NIAID/NIDA

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DO - 10.1016/S2468-2667(21)00258-9

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SN - 2468-2667

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JO - Lancet Public Health

JF - Lancet Public Health

IS - 2

ER -

The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

Abstract

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