Associations of hepatitis C virus (HCV) antibody positivity with opioid, stimulant, and polysubstance injection among people who inject drugs (PWID) in rural U.S. communities
Year: 2023
Type: article
Study design: Observational Study
Abstract: BACKGROUND: People who inject drugs (PWID) in the rural U.S. often inject stimulants, alone or with opioids. The impact of these substance use patterns may influence HCV risk behaviors. This analysis examines the associations of HCV antibody positivity with injecting only opioids, only stimulants (methamphetamine/cocaine), and opioids and stimulants together among rural PWID. METHODS: The Rural Opioid Initiative (ROI) consists of eight research sites that enrolled people who use drugs in rural communities in ten U.S. states from 2018 to 2020. This cross-sectional analysis included adult participants who resided in a study area and injected any drug in the past 30 days. The primary outcome was HCV antibody positivity. The exposure of interest was injection drug use classified as only opioids, only stimulants, separate injections of opioids and stimulants, and same-syringe injection of both in the past 30 days. We used multivariable log-binomial regression with generalized linear mixed models to generate prevalence ratios (P.R.) adjusted for demographics, injection history, health insurance, and substance use treatment. RESULTS: Among 3,084 participants enrolled in the ROI, 1,982 met inclusion criteria. Most participants injected opioids and stimulants in the same syringe (34%) or separately (21%), followed by injecting only stimulants (26%), and injecting only opioids (19%). Half (51%) were HCV antibody positive. Compared to people who injected only stimulants, HCV antibody positivity was more prevalent among people who injected opioids alone (aPR=1.62, 95% CI:(1.29-2.03)), injected both opioids and stimulants separately (aPR=1.61, 95% CI:(1.32-1.95)), and in the same syringe (aPR=1.54, 95% CI:(1.28-1.85)). CONCLUSION: HCV antibody positivity, indicating prior exposure, was highest among those who had recently injected opioids, alone or with stimulants. Additional nucleic acid testing is necessary to confirm active infection. More research is needed to determine the underlying causes of HCV antibody positivity by injection use.
Institutions: The Ohio State University, University of North Carolina at Chapel Hill, Wake Forest University Health Sciences, Wake Forest University, University of Washington, University of Kentucky, Oregon Health & Science University, Tufts University, West Virginia University, RTI International, University of Chicago, University of Massachusetts Chan Medical School, Baystate Health, University of Wisconsin–Madison
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,070
Funders: Appalachian Regional Commission, National Institutes of Health, Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, National Institute on Drug Abuse, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Advancing Translational Sciences
Awards: G1748107206, Community-based, client-centered prevention homes to address the rural opioid epidemic, Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE), Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE), Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern Appalachia, G2901389100, G3114260083, Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio, G3599897312, Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study, G3700831417, Rural West Virginia Responds to Opioid Injection Epidemics: From Data to Action, Peer-based Retention of people who Use Drugs in Rural Research (PROUD-R2), Community-based, client-centered prevention homes to address the rural opioid epidemic, Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE), Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE), Ending transmission of HIV, HCV, and STDs and overdose in rural communities of people who inject drugs (ETHIC), Next-Generation Sequencing Center for GHOSTing Hepatitis C Virus: Transforming Community Based Molecular Surveillance and Outbreak Investigation, Off-label Use of Rapid Response Fentanyl Test Strips as an Opioid Overdose Prevention Strategy, Mitigating the Outcomes Associated with the Injection Drug Use Epidemic in Southern Appalachia, G6136032161, Oregon HIV/Hepatitis and Opioid Prevention and Engagement (OR-HOPE) Study, Ending transmission of HIV, HCV, and STDs and overdose in rural communities of people who inject drugs (ETHIC), Rural Comorbidity and HIV consequences of Opioid use Research and Treatment Initiative (Rural cohort), G7207243972, The role of injection partnerships and preferences for reducing HCV risk: Giving a voice to young women in rural Appalachia., Implementing a Community-Based Response to the Opioid Epidemic in Rural Ohio, Chicago Center for Diabetes Translation Research, West Virginia Clinical and Translational Science Institute: A Statewide Organization Building Research Excellence and Engaging Communities to Improve Health, Spatio-temporal Methods for Surveillance of the Opioid Syndemic, The effect of opioids, stimulants, and the simultaneous use of both on the hepatitis C virus (HCV) cascade of care in rural communities in the United States
OpenAlex ID: W4387396876