Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut

Abstract

Introduction and Aims Little is known about injection-associated risk behaviours, knowledge and seroprevalence of viral infections among people who inject drugs (PWID) in nonurban locales in the US. Harm reduction services are more available in urban locales. The present study examined a cohort of active PWID residing in non-urban areas of Connecticut to investigate how primarily injecting in urban or non-urban areas was associated with injection-associated risk behaviours, knowledge and prevalence of blood-borne viruses Design and Methods We described the sample and performed bivariate and multivariable analyses on injection-associated risk behaviours, HIV/hepatitis/overdose knowledge, and baseline serological data to identify differences between individuals who injected primarily in nonurban locales and those who did not. Results Harm reduction knowledge and use of harm reduction services were poor in both groups. Those injecting most often in urban settings were 1.88 (1.19, 2.98 95% confidence interval) times more likely to engage in at least one injection-associated risk behaviour than their nonurban counterpart. Seroprevalence rates (23.6% for hepatitis B virus, 39.2% for hepatitis C virus, and 1.1% for HIV) were no different between the two groups. Discussion and Conclusions The data provided little evidence that the benefits of urban harm reduction programs such as syringe exchange, risk reduction interventions, and education programs have penetrated into this nonurban population, even among those who injected in urban locales where such programs exist. Harm reduction interventions for nonurban communities of PWID are needed to reduce HIV and hepatitis B and C transmission.

Knowledge of hepatitis C and treatment willingness amongst people who inject drugs in an era of direct acting antivirals

“…No single tool exists to assess an individual’s knowledge of HCV, making comparison of the findings of individual studies difficult. However, our findings identified similar factors and themes associated with a greater or lesser degree of HCV knowledge amongst PWID as seen in previous studies, suggesting that these various methods of knowledge assessment are in fact measuring similar constructs (Grau, Zhan, & Heimer, 2016; Marshall et al, 2015; Surjadi et al, 2011). A second limitation was that a large number of study participants answered “I don’t know” or declined to answer at least one of the knowledge questions.…”

Injection drug use, HIV/HCV, and related services in nonurban areas of the United States: A systematic review

“…Eight studies addressed injection equipment other than syringes. Two, from the same Connecticut-based study, reported slightly differing prevalence for sharing cookers (18.8% and 17.8%), rinse water (31.2%, 30.0%), and drug mixing water (33.8%, 34.8%) in the past 30 days (Grau et al, 2016; Heimer et al, 2014). Other studies grouped non-syringe injection equipment together; these included two community-based Kentucky studies, with one reporting that 42.1% of PWID shared cotton/cookers/rinse water (Havens et al, 2007) and the other that 41.9% of HCV-positive and 26.0% of HCV-negative PWID, respectively, shared cookers/cotton/rinse water in the past 6 months (Havens et al, 2013).…”

“…Twelve studies reported measures of syringe sharing. Three from a single cohort of PWID in southwestern Connecticut reported syringe-mediated sharing (not defined) at 13% (Akselrod et al, 2014), receptive sharing at 21.9% (Grau et al, 2016), and “syringe sharing” at 20.5% (Heimer et al, 2014). A community-based sample in Appalachian Kentucky documented receptive and distributive syringe sharing at 10.5% and 26.3%, respectively (Havens et al, 2007), while a later study documented prevalence of 16.7% for receptive and distributive sharing combined (Young et al, 2013b).…”

“…Two of these studies, from the Connecticut cohort, looked at factors associated with a composite injection-associated risk behavior outcome variable based on participants’ reports of engaging in up to six listed risk behaviors in the last 30 days (i.e., receptive sharing, “syringe mediated sharing,” sharing drug in liquid form, sharing cookers, sharing drug-mixing water, sharing rinse water). Grau et al (2016) looked at factors associated with reporting at least one of these behaviors and identified White race, having at least a high school degree, and having ≥6 injection partners in past 6 months as positively associated with injection risk behavior(s). Heimer et al (2014) used this measure as a 6-item continuous outcome variable and found that older age, CES-D depression score normal or mild, injecting in one’s own residence, and higher social support scores were negatively associated with higher risk scores, while larger injection network size and higher hepatitis knowledge score were positively associated with higher scores.…”

Development, validation, and potential applications of the hepatitis C virus injection-risk knowledge scale (HCV-IRKS) among young opioid users in New York City

“…Researchers have attempted to measure HCV knowledge in various populations, including PWID (Grau et al, 2016; Dunn et al, 2013; Bryant, 2014; Zeremski et al, 2014; Marshall et al, 2015; Carey et al, 2005; O’Brien et al, 2008; Stein et al, 2007; Heimer et al, 2002; Stein et al, 2001; Evans et al, 2005); however, few HCV knowledge measures have been developed specifically for PWID, and none to our knowledge has been thoroughly psychometrically evaluated among PWID. While general HCV knowledge is important, injection-specific risk factors are typically not emphasized or covered in detail in existing measures, therefore these measures’ usefulness for targeting populations most in need of education and testing remains unknown.…”