Protocol for a systematic review of treatment adherence for HIV, hepatitis C and tuberculosis among homeless populations
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PROTOCOL
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Protocol for a systematic review of treatment adherence for HIV, hepatitis C and tuberculosis among homeless populations Luke Johnson1,2, Dan Lewer1* , Robert W. Aldridge3, Andrew C. Hayward1 and Alistair Story1
Abstract Background: Homelessness is a global issue and HIV, hepatitis C and tuberculosis are known to be prevalent in this group. Homeless populations face significant barriers to care. We aim to summarise evidence of treatment initiation and completion for homeless populations with these infections, and their associated factors, through a systematic review and meta-analysis. Methods: We will search MEDLINE, Embase and CINAHL for all study types and conference abstracts looking at either (1) treatment initiation in a cohort experiencing homelessness with at least one of HIV, hepatitis C, active tuberculosis and/or latent tuberculosis infection (LTBI); (2) treatment completion for those who initiated treatment. We will perform a meta-analysis of the proportion of those with each infection who initiate and complete treatment, as well as analysis of individual and health system factors that may affect adherence levels. We will evaluate the quality of research papers using the Newcastle-Ottawa scale. Discussion: Given the political emphasis on global elimination of these diseases, and the current lack of understanding of effective and equitable treatment adherence strategies in homeless populations, this review will provide insight to policy-makers and service providers aiming to improve homeless healthcare. Systematic review registration: PROSPERO CRD42019153150 Keywords: Homelessness, Inequality, Inclusion health, HIV, Hepatitis C, Tuberculosis, LTBI, Treatment adherence, Treatment initiation, Treatment completion
Background The last global survey by the United Nations (UN) in 2005 estimated that 100 million people worldwide were homeless [1]. More recent estimates in 2017 suggest the number is around 150 million people—approximately 2% of the global population [2]. Recent reports show * Correspondence: [email protected] 1 Collaborative Centre for Inclusion Health, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HT, UK Full list of author information is available at the end of the article
homelessness is growing across almost all European countries [3] and is a significant problem in the USA [4]. With so many people represented within this group, and most with very complex health needs and extremely poor health outcomes [5], homeless health remains an important area of research. A 2012 systematic review and meta-analysis of prevalence data found studies reporting 0.3 to 21.1% of homeless people have HIV, 3.9 to 36.2% have hepatitis C infection, and 0.2 to 7.7% have tuberculosis [6]. Given the extremely high burden of these communicable
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduct
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