ArticleThe Lancet. Public health2022
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.
Article in The Lancet. Public health, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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26 citing papers in PubMed, 1 synthesis or guideline pooled it, 45 citations in OpenAlex.
- Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review.The Lancet. Global health · 2023Pooled it
- Healthcare First: Delivering Immediate, Non-Contingent, and Coordinated Services Through the Street Medicine Model.Research square · 2026Article
- The Housing Instability Scale: Determining a Cutoff Score and Its Utility for Contextualizing Health Outcomes in People Who Use Drugs.International journal of environmental research and public health · 2025Article
- Modeling the impact of changing drug markets and structural determinants on HCV and/or HIV transmission among people who inject drugs in the United States: A rural and urban comparison.The International journal on drug policy · 2025Article
- Impact and cost-effectiveness of interventions to eliminate hepatitis C virus among people who inject drugs in Haiphong, Vietnam.The International journal on drug policy · 2025Article
- Substance Checking Outreach and PrEP Engagement (SCOPE) Study: protocol for a non-randomised clinical trialBMJ open · 2025Article
- Rising transphobia and disparities in drug-related harm experienced by transgender and gender-diverse people.Harm reduction journal · 2025Review
- Challenges and Opportunities for Treating Hepatitis C Amongst People Who Use Drugs: Experience of an Integrated Mobile Clinic in Baltimore City.Journal of viral hepatitis · 2025Article
- Knowledge, Attitudes, and Practices Regarding HIV/AIDS Among Adolescents in Internally Displaced Persons (IDP) Camps in Mogadishu, Somalia: A Descriptive Cross-Sectional Study.AIDS research and treatment · 2025Article
- Improving health and housing outcomes through a simulation and economic model: an evidence-based protocol of a group model building approach to develop an agent-based model.Frontiers in public health · 2025Article
- Justice as care: embedding legal services into HIV care to address health-harming legal needs.Critical public health · 2025Article
- Progress and challenges in the elimination of hepatitis C among people who inject drugs in Germany: results of a pilot study for a national monitoring system, 10 years after the first data collection.Harm reduction journal · 2024Article
- Sexually transmitted and blood-borne infections by sex, methamphetamine use, and houselessness before, at, and after HIV diagnosis in Manitoba, Canada.IJID regions · 2024Article
- Elimination of HCV Infection: Recent Epidemiological Findings, Barriers, and Strategies for the Coming Years.Viruses · 2024Review
- Prevalence of HCV Infection Among People Experiencing Homelessness in Madrid, Spain.JAMA network open · 2024Article
- Article
- An Analysis of Social Determinants of Health and Their Implications for Hepatitis C Virus Treatment in People Who Inject Drugs: The Case of Baltimore.Open forum infectious diseases · 2024Article
- Health-related quality of life among people who inject drugs in Australia.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2023Observational
- Evaluating the prevalence of current hepatitis C infection and treatment among Aboriginal and Torres Strait Islander peoples who inject drugs in Australia: The ETHOS engage study.Drug and alcohol review · 2023Observational
- Analysis of the UK Government's 10-Year Drugs Strategy-a resource for practitioners and policymakers.Journal of public health (Oxford, England) · 2023Article
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Authors and funding
7 authors at 4 institutions in 3 countries.
Funding
Abstract
backgroundA considerable proportion of people who inject drugs are unstably housed. Although unstable housing is associated with HIV and HCV infection among people who inject drugs, its contribution to transmission is unknown. We estimated the global and national proportions of incident HIV and HCV infections among people who inject drugs attributed to housing instability from 2020 to 2029.
methodsIn this modelling study, we developed country-level models of unstable housing and HIV and HCV transmission among people who inject drugs in 58 countries globally, calibrated to country-specific data on the prevalences of HIV and HCV and unstable housing. Based on a recently published systematic review, unstably housed people who inject drugs were assumed to have a 39% (95% CI 6-84) increased risk of HIV transmission and a 64% (95% CI 43-89%) increased risk of HCV transmission. We used pooled country-level estimates from systematic reviews on HCV and HIV prevalence in people who inject drugs. Our models estimated the transmission population attributable fraction (tPAF) of unstable housing to HIV and HCV transmission among people who inject drugs, defined as the percentage of infections prevented from 2020 to 2029 if the additional risk due to unstable housing was removed.
findingsOur models were produced for 58 countries with sufficient data (accounting for >66% of the global people who inject drugs population). Globally, we project unstable housing contributes 7·9% (95% credibility interval [CrI] 2·3-15·7) of new HIV infections and 11·2% (7·7-15·5) of new HCV infections among people who inject drugs from 2020 to 2029. Country-level tPAFs were strongly associated with the prevalence of unstable housing. tPAFs 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-income or middle-income countries (HIV 6·6% [95% CrI 1·8-13·1]; HCV 8·3% [95% CrI 5·5-11·7]). tPAFs for HIV and HCV were highest in Afghanistan, Czech Republic, India, USA, England, and Wales where unstable housing contributed more than 20% of new HIV and HCV infections.
interpretationUnstable housing is an important modifiable risk factor for HIV and HCV transmission among people who inject drugs in many countries. The study emphasises the importance of implementing initiatives to mitigate these risks and reduce housing instability.
fundingNational Institute for Health Research and National Institute of Allergy and Infectious Diseases and National Institute for Drug Abuse.
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