Prevalence of Human Immunodeficiency Virus, Hepatitis C Virus, and Hepatitis B Virus Among Homeless and Nonhomeless United States Veterans

Background. Veterans are disproportionately affected by human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Homeless veterans are at particularly high risk for HIV, HCV, and HBV due to a variety of overlapping risk factors, including high rates of mental health disorders and substance use disorders. The prevalence of HIV, HCV, and HBV among homeless veterans nationally is currently unknown. This study describes national testing rates and prevalence of HIV, HCV, and HBV among homeless veterans. Methods. Using data from the Department of Veterans Affairs (VA) Corporate Warehouse Data from 2015, we evaluated HIV, HCV, and HBV laboratory testing and infection confirmation rates and diagnoses on the Problem List for nonhomeless veterans and for veterans utilizing homeless services in 2015. Results. Among 242 740 homeless veterans in VA care in 2015, HIV, HCV, and HBV testing occurred in 63.8% (n = 154 812), 78.1% (n = 189 508), and 52.8% (n = 128 262), respectively. The HIV population prevalence was 1.52% (3684/242 740) among homeless veterans, compared with 0.44% (23 797/5 424 685) among nonhomeless veterans. The HCV population prevalence among homeless veterans was 12.1% (29 311/242 740), compared with 2.7% (148 079/5 424 685) among nonhomeless veterans, while the HBV population prevalence was 0.99% (2395/242 740) for homeless veterans and 0.40% (21 611/5 424 685) among nonhomeless veterans. Conclusions. To our knowledge this work represents the most comprehensive tested prevalence and population prevalence estimates of HIV, HCV, and HBV among homeless veterans nationally. The data demonstrate high prevalence of HIV, HCV, and HBV among homeless veterans, and reinforce the need for integrated healthcare services along with homeless programming.