Healthcare contact and treatment uptake following hepatitis C virus screening and counseling among rural Appalachian people who use drugs

Abstract

Background Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods 503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results 150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. Conclusion While only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting.

The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals

“…Morbidity and mortality related to chronic HCV infection continues to increase, driven by large populations of people living with HCV who acquired the infection decades ago. While potentially curative treatment for HCV infection has been available for over 15 years, these medications were poorly tolerated and had low cure rates, resulting in fewer than 15% of those infected being treated. HCV cure is associated with reduced morbidity and mortality, but low treatment uptake and poor efficacy with older medications limited population‐level effects.…”

Knowledge of Hepatitis C Risk Factors is Lower in High Incidence Regions

“…(Alam-Mehrjerdi et al, 2016;Mah et al, 2017;Zeremski et al, 2014) Hepatitis C education campaigns can improve knowledge, (Norton et al, 2014;Surjadi et al, 2011) and a formal hepatitis C education program can shorten time to treatment and improve virologic response. (Lubega, Agbim, Surjadi, Mahoney, & Khalili, 2013) In a screening program focused on people who use drugs in rural Appalachia, a portion of which includes Virginia, only 8% received treatment after testing positive for hepatitis C, (Stephens, Young, & Havens, 2017) demonstrating a significant need for improvement in linkage to care and treatment. Given the limited knowledge within our cohort, there is room for improvement through educational campaigns.…”

Implementation of a Collaborative HIV and Hepatitis C Screening Program in Appalachian Urgent Care Settings

“…4 , 5 A recent study has demonstrated a need for further HCV testing and intervention in the Appalachian region. 6 Among Central Appalachia states, West Virginia currently has the second-highest incident rate of HCV in the nation. 4 Of particular concern is the fact that HCV co-infection has been observed in rates as high as 90% among human immunodeficiency virus (HIV) positive injection drug users.…”