Hepatitis C antibody prevalence, correlates and barriers to care among people who inject drugs in Central California

Abstract

Hepatitis C (HCV) infection among people who inject drugs (PWID) is a major public health concern. We examined correlates of HCV antibody (anti‐HCV) seropositivity and characteristics of prior HCV testing and treatment among PWID in Fresno, California, which has among the highest prevalence of injection drug use (IDU) in the United States. We surveyed 494 peer‐recruited PWID (≥18 years of age) in 2016 about their experiences with HCV testing and treatment, and conducted HCV and HIV antibody testing for all participants. Bivariate analyses and multivariable logistic regressions were used to identify correlates of anti‐HCV seropositivity. A majority (65%) tested positive for anti‐HCV, with 32% of those being unaware of their HCV status. Anti‐HCV seroprevalence was independently and positively associated with older age (AOR = 1.11 per year, 95% CI = 1.06, 1.17), years injecting (AOR = 1.08 per year, 95% CI = 1.03, 1.13), distributive syringe sharing (AOR = 2.76, 95% CI = 1.29, 5.94), having syringes confiscated by police (AOR = 2.65, 95% CI = 1.22, 5.74), ever trading sex (AOR = 3.51, 95% CI = 1.40, 8.81) and negatively associated with being Black/African American (non‐Hispanic) (AOR = 0.06, 95% CI = 0.01, 0.47). Prior HCV testing was associated with older age, ever getting syringes from a syringe services program, and having interactions with police. For those aware of their anti‐HCV seropositivity, only 11% had initiated treatment; reasons for not seeing a physician regarding diagnosis included not feeling sick (23%), currently using drugs/alcohol (19%) and not knowing where to go for HCV medical care (19%). Our findings highlight the importance of expanding community‐based access to sterile syringes alongside HCV testing and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking testing and treatment.

The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019

“…Since 2015, ASIR of HCV infection has increased more rapidly in women than in men globally, which is consistent with previous studies (15). Compared with China and India, the United States had the highest ASIR in 2019, and the ASIR of male patients in the United States was significantly higher than that of women, which may be because the main risk factor for HCV infection in the United States is intravenous drug use, and drug users are mainly men (45,48). ASIR among Indian women has gradually declined since 1990 probably because 99% of HCV infections of IDUs were young men (55).…”

“…Studies have found that younger patients (18-29 years) have lower treatment rates than older patients (50-59 years) and that patients with commercial insurance have higher rates of treatment than those on Medicaid (42)(43)(44). In addition, patients with a history of drug use, patients infected with HIV, and patients with decompensated cirrhosis are also less likely to receive treatment (43,45). Of note, intravenous drug use is the main factor of HCV infection in the United States with genotype 3 dominated (45), and genotype 3, especially genotype 3b patients with liver cirrhosis, has a significantly lower success rate of DAAs treatment than other genotypes (46,47).…”

Treating Hepatitis C Virus Infection in Jails as an Offset to Declines in Treatment Activity in the Community, New York City, NY, 2014–2020

“…People who use drugs (PWUD) account for a large proportion of HCV cases, but they also experience barriers to care such as underdiagnosis and challenges with linkage to care in the community. 23 This study found that PWUD who had interactions with police were more likely to have prior HCV testing. Therefore, although access to HCV care in the community may be challenging for PWUD for various reasons, those who have interaction with the criminal justice system may be presented with opportunities for HCV testing and treatment.…”