HCV prevalence and phylogenetic characteristics in a cross‐sectional, community study of young people who inject drugs in New York City: Opportunity for and threats to HCV elimination

Abstract

Background and AimsIn the United States, the opioid epidemic has led many young people who use opioids to initiate injection drug use, putting them at risk for hepatitis C virus (HCV) infection. However, community surveys to monitor HCV prevalence among young people who inject drugs (YPWID) are rare.MethodsAs part of Staying Safe (Ssafe), a trial to evaluate an HCV‐prevention intervention, a community‐recruited sample of 439 young people who use opioids (ages 18−30) in New York City (NYC) were screened from 2018 to 2021. Screening procedures included a brief verbal questionnaire, a visual check for injection marks, onsite urine drug testing, rapid HCV antibody (Ab) testing, and dried blood spot (DBS) collection. DBS specimens were sent to a laboratory for HCV RNA testing and phylogenetic analysis to identify genetic linkages among HCV RNA‐positive specimens. Multivariable logistic regression was used to assess associations between HCV status (Ab and RNA) and demographics and drug use patterns.ResultsAmong the 330 participants who reported injecting drugs (past 6 months), 33% (n = 110) tested HCV Ab‐positive, 58% of whom (n = 64) had HCV RNA‐positive DBS specimens, indicating active infection. In multivariable analysis, visible injection marks (AOR = 3.02; p < 0.001), older age (AOR = 1.38; p < 0.05), and female gender (AOR = 1.69; p = 0.052) were associated with HCV Ab‐positive status. Visible injection marks were also associated with HCV RNA‐positive status (AOR = 5.24; p < 0.01). Twenty‐five percent of RNA‐positive specimens (14/57) were genetically linked.ConclusionThe relatively low prevalence of active infection suggests the potential impact of treatment‐as‐prevention in reducing HCV prevalence among YPWID. Targeted community serosurveys could help identify actively infected YPWID for treatment, thereby reducing HCV incidence and future transmissions.