Breakdowns in the HCV care continuum may have adverse effects on HCV-treatment readiness and willingness. Improved public health and practice approaches are needed to address these barriers to effectively engage young PWID in care.

Background Abscesses commonly occur among people who inject drugs (PWID). However, whether the risks are comparable between males and females, and the impact of sex work on abscess risk is unclear. The goal of this study was to examine the contemporary associations of gender and sex work with the risk of abscesses in PWID. Methods Combining data from two cross-sectional studies conducted in the Greater Boston Area with people at risk for HIV and hepatitis C virus (HCV), we used the following inclusion criteria: age 18–45 years and report of illicit or non-prescription drug injection within the 30 days prior to the survey. Information on demographics, injection-mediated risks, and sexual behaviors was collected using Audio Computer-Assisted Self-Interview Software. Multivariable logistic regressions were used to model associations. Results The study sample included 298 people including 30% were female. Females were more likely than men to report sex work (28% vs. 16%, p= 0.012) and abscess during their lifetime (55% vs. 37% p=0.004). Among the females, engaging in sex work increased by >5-fold the odds of reporting abscesses [Adjusted odds ratio 5.42; 95% CI: 1.27, 23.10]. There was no association between sex work and abscesses among men. Discussion We found a female-specific association between sex work, injection drug use, and abscesses among PWID. Although the cross-sectional designs precluded causal inferences, longitudinal studies could enhance understanding of gender-associated risks for abscesses and inform the development of harm reduction interventions.

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Objectives. Crystal methamphetamine (“meth”) use among youth living in rural areas is higher than the national average. Given how drastically meth affects teeth (i.e., “meth mouth”), engaging dental professionals as one of multiple channels in rural areas to deliver meth prevention messaging is a novel approach. The objective of this research was to assess the feasibility and acceptability of incorporating meth use prevention messaging into dental visits with teenagers. Methods. We conducted phenomenological, qualitative research with dental practitioners, teens, and parents/guardians in three communities in North Idaho, from 2015 to 2016. We recruited practitioners using a snowball sampling strategy and placed phone calls to dental practices and contacted teens and parents through schools, libraries, local sporting events, and word-of-mouth. Using NVivo 12-Plus, parent- and teen-specific codebooks and themes were developed from guides and transcripts. Transcripts of the dentists and hygienists were reviewed to ascertain the main ideas and themes. Results. Overall, practitioner, teen, and parent participants viewed meth prevention messages delivered by dental professionals as acceptable and feasible. Compared to those in private practice, public health dental providers were invested in meth prevention and were eager to help. Barriers to overall acceptability and feasibility included hygienists’ low self-efficacy to deliver a communication-based intervention, infrequency of dental visits impacting the ability to reach enough teens through this venue, and the fact that teens could feel “targeted” by providers. Teens also raised concerns about scary messages exacerbating preexisting dental visit anxiety. Facilitators included the following: dental practitioners already engaging in health education with their patients, parents, and teens seeing dental professionals as appropriate purveyors of antimeth messaging and support for increased meth prevention efforts given the impact of meth use in their communities. Conclusions. Well-crafted, developmentally appropriate meth prevention messages would likely be well received by teens and supported by parents in dental offices. These data are being used to develop a novel, theory-based communication and behavioral strategy to integrate dental professionals into the delivery of messages aimed at preventing the initiation of meth use among rural Idaho teens.

Integration of genetic, social network, and spatial data has the potential to improve understanding of transmission dynamics in established HCV epidemics. Sequence data were analyzed from 63 viremic people who inject drugs recruited in the Boston area through chain referral or time-location sampling. HCV subtype 1a was most prevalent (57.1%), followed by subtype 3a (33.9%). The phylogenetic distances between sequences were no shorter comparing individuals within versus across networks, nor by location or time of first injection. Social and spatial networks, while interesting, may be too ephemeral to inform transmission dynamics when the date and location of infection are indeterminate.

Background Abscesses are a common health issue for people who inject drugs (PWID). Females have a higher risk of abscesses, yet it is unclear if the risks are comparable among female sub-populations. The goal of this study was to examine the associations between gender, sex work, and risks of abscesses in PWID.Methods We combined data from two cross-sectional studies conducted in the greater Boston area with 225 participants aged 18–45 years, who participated in injection drugs use in the previous 30 days. Demographics, injection-mediated risks, and sexual behaviors were collected using ACASI. Injection drug use was defined as “high” if injection frequencies exceeded the median. Odds ratios from multivariable logistic regressions were used to represent the associations; all analyses were gender-stratified.ResultsThe cohort was 31% women (71/225). White race was more common in women than men (89% vs. 63%). Women were more likely than men to report: sex work 31% vs. 14%, heavy heroin use 56% vs. 40%, HCV 76% vs. 61%, abscesses 54% vs. 38%. Controlling for confounders, females who engaged in sex work had >7 times higher odds of reporting abscesses [AOR 7.51; 95% CI (1.41, 40.07)]. There was no association between sex work in men and increased risk for abscess.Conclusion We found a gender-specific association between sex work, injection drug use, and abscesses among PWID. The cross-sectional designs precluded causal inferences; further longitudinal studies are necessary to better understand the gender-associated risks for abscesses and to develop harm reduction interventions.Factors Associated with Abscess for Female PWID, Massachusetts, 2015–2016 (n = 71) Predictor N (%), median (IQR) OR (95% CI) AOR Sex work22 (31)3.27 (1.10, 9.78)7.51 (1.41, 40.07)Age32 [30,36]0.97 (0.89, 1.06)0.90 (0.78, 1.04)Heavy heroin use40 (56)1.82 (0.71, 4.71)3.60 (0.95, 13.69)Heavy cocaine use15 (21)0.71 (0.23, 2.21)0.12 (0.02, 0.84)White63 (89)1.17 (0.27, 5.11)0.32 (0.04, 2.94)High school education or greater49 (69)0.55 (0.20, 1.54)0.43 (0.11, 1.74)Homeless59 (83)4.38 (1.07, 17.85)5.16 (0.95, 28.13)HCV+54 (76)4.68 (1.31, 16.66)11.26 (1.85, 68.67)HIV+2 (3)0.86 (0.05, 14.39)0.44 (0.01, 26.84)Needle exchange program50 (70)0.62 (0.22, 1.74)0.41 (0.10, 1.70)Disclosures A. Wurcel, Tufts Medical Center, Tufts University School of Medicine: Grant Investigator, Grant recipient, Merck, BMS and Research support

Integration of genetic, social network, and spatial data has the potential to improve understanding of transmission dynamics in established HCV epidemics. Sequence data were analyzed from 63 viremic people who inject drugs recruited in the Boston area through chain referral or time-location sampling. HCV subtype 1a was most prevalent (57.1%), followed by subtype 3a (33.9%). The phylogenetic distances between sequences were no shorter comparing individuals within versus across networks, nor by location or time of first injection. Social and spatial networks, while interesting, may be too ephemeral to inform transmission dynamics when the date and location of infection are indeterminate.