These findings strongly suggest that the national increase in acute HCV infection is related to the country's opioid epidemic and associated increases in IDU.
In 2015, a large human immunodeficiency virus (HIV) outbreak occurred among persons who inject drugs (PWID) in Indiana. During 2016–2019, additional outbreaks among PWID occurred across the United States. Based on information disseminated by responding health departments and Centers for Disease Control and Prevention (CDC) involvement, we offer perspectives about characteristics of and public health responses to 6 such outbreaks. Across outbreaks, injection of opioids (including fentanyl) or methamphetamine predominated; many PWID concurrently used opioids and methamphetamine or cocaine. Commonalities included homelessness or unstable housing, previous incarceration, and hepatitis C virus exposure. All outbreaks occurred in metropolitan areas, including some with substantial harm reduction and medical programs targeted to PWID. Health departments experienced challenges locating case patients and contacts, linking and retaining persons in care, building support to strengthen harm-reduction programs, and leveraging resources. Expanding the concept of vulnerability to HIV outbreaks and other lessons learned can be considered for preventing, detecting, and responding to future outbreaks among PWID.
A cure is now the norm in HCV treatment, and there is an increasing need to address the barriers to treating PWID, the population with the highest burden of infection. Understanding treatment candidacy assessments is essential to improving uptake. This study provides insight into how clinicians view treatment candidacy in this era of DAAs and can help identify supportive treatment environments and concurrent programs.
Background
Current diagnostic tests for Hepatitis C Virus (HCV) involve
phlebotomy and serologic testing for HCV antibodies (anti-HCV) and RNA,
which are not always feasible. Dried blood spots (DBS) present a minimally
invasive sampling method and are suitable for sample collection, storage and
testing.
Objectives
To assess the utility of DBS in HCV detection, we evaluated the
sensitivity and specificity of DBS for anti-HCV and HCV RNA detection
compared to plasma specimens.
Study design
This cross-sectional validation study was conducted in the context of
an existing prospective study of HCV in young injection drug users. Blood
samples were collected by venipuncture into serum separator tubes (SST) and
via finger stick onto Whatman 903® protein-saver cards. Plasma
samples and eluates from the DBS were tested for anti-HCV using
either a third generation enzyme-linked or chemiluminescent immunoassay
(IA), and HCV RNA using discriminatory HCV transcription-mediated
amplification assay (dHCV TMA). DBS results were compared to their
corresponding plasma sample results.
Results
148 participants were tested for anti-HCV and 132 participants were
tested for HCV RNA. For anti-HCV, the sensitivity of DBS was 70%,
specificity was 100%, positive predictive value (PPV) was 100%, negative
predictive value (NPV) was 76% and Kappa was 0.69. For HCV RNA, the
sensitivity of DBS was 90%, specificity was 100%, PPV was 100%, NPV was 94%
and Kappa was 0.92.
Conclusions
DBS are sensitive and very specific in detecting anti-HCV and HCV
RNA, demonstrate good correlation with plasma results, and have potential to
facilitate diagnosis of HCV infection.
BackgroundPeople who inject drugs (PWID) are at highest risk for hepatitis C virus (HCV) infection, yet many remain unaware of their infection status. New anti-HCV rapid testing has high potential to impact this.MethodsYoung adult (<30 years) active PWID were offered either the rapid OraQuick® or standard anti-HCV test involving phlebotomy, then asked to complete a short questionnaire about testing perceptions and preferences. Sample characteristics, service utilization, and injection risk exposures are assessed with the HCV testing choice as the outcome, testing preferences, and reasons for preference.ResultsOf 129 participants: 82.9% (n = 107) chose the rapid test. There were no significant differences between those who chose rapid vs. standard testing. A majority (60.2%) chose the rapid test for quick results; most (60.9%) felt the rapid test was accurate, and less painful (53.3%) than the tests involving venipuncture.ConclusionsOraQuick® anti-HCV rapid test was widely accepted among young PWID. Our results substantiate the valuable potential of anti-HCV rapid testing for HCV screening in this high risk population.
HIV self-management is central to the health of people living with HIV and is comprised of the daily tasks individuals employ to manage their illness. Women living with HIV are confronted with social context vulnerabilities that impede their ability to conduct HIV self-management behaviors, including demanding social roles, poverty, homelessness, decreased social capital, and limited access to health care. We examined the relationship between these vulnerabilities and HIV self-management in a cross-sectional secondary analysis of 260 women living with HIV from two U.S. sites. All social context variables were assessed using validated self-report scales. HIV Self-Management was assessed using the HIV Self-Management Scale that measures daily health practices, HIV social support, and the chronic nature of HIV. Data were analyzed using appropriate descriptive statistics and multivariable regression. Mean age was 46 years and 65% of participants were African-American. Results indicated that social context variables, particularly social capital, significantly predicated all domains of HIV self-management including daily health practices (F=5.40, adjusted R2=0.27, p<0.01), HIV social support (F=4.50, adjusted R2=0.22, p<0.01), and accepting the chronic nature of HIV (F=5.57, adjusted R2=0.27, p<0.01). We found evidence to support the influence of the traditional social roles of mother and employee on the daily health practices and the chronic nature of HIV domains of HIV self-management. Our data support the idea that women’s social context influences their HIV self-management behavior. While social context has been previously identified as important, our data provide new evidence on which aspects of social context might be important targets of self-management interventions for women living with HIV. Working to improve social capital and to incorporate social roles into the daily health practices of women living with HIV may improve the health of this population.
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