Silence Surrounding Hepatitis C Status in Risk Relationships Among Rural People Who Use Drugs

Abstract

Hepatitis C virus (HCV) has reached epidemic proportions in rural Central Appalachia in recent years. We sought to identify demographic, behavioral, and interpersonal characteristics associated with HCV serostatus disclosure among high risk people who use drugs (PWUD) in Appalachian Kentucky. HCV antibody-positive participants (n=243), drawn from the fifth follow-up assessment of a longitudinal study of rural PWUD, completed interviewer-administered questionnaires eliciting demographic and interpersonal characteristics, risk behaviors, and information about HCV disclosure. We assessed correlates of HCV disclosure using gender-stratified multivariate logistic regression. Participants reported having disclosed their HCV-positive status to a current sex partner (44.0%), family member (35.8%), close friend (9.5%), or past sex partner (6.6%). Of those reporting current (n=72) or past (n=215) injection drug use (IDU), only 2.8% disclosed to current and 0.9% disclosed to past IDU partners, respectively. Female participants were more likely than male participants to disclose to current sex partners and family member(s). In multivariate analysis, adjusting for time since testing HCV positive, older age and lifetime history of drug treatment were associated with decreased odds of HCV disclosure among females, while only lifetime history of drug treatment was associated with decreased odds of HCV disclosure among males. In summary, the almost complete absence of disclosure to current or former injection drug use partners was concerning. However, most participants (69.1%) reported disclosing their HCV status to at least one of their social referents, suggesting that family members, partners, and friends of people living with HCV could play a critical role in encouraging uptake of treatment. Although further research is warranted, it is clear that interventions are needed to encourage HCV disclosure among those most at risk of transmitting HCV.

Risks for acquiring hepatitis C virus among women in the United States

“…Women shared that it is considered inappropriate to discuss HCV in settings where people were using drugs and only told certain partners their HCV‐positive status [6,14]. In Hofmeister et al., (2017), women were 7% less likely to disclose their HCV‐positive status if they depended on someone else for most of their support, compared to women who were not depended.…”

Social network predictors of recent and sustained injection drug use cessation: findings from a longitudinal cohort study

“…The median sample age at baseline was 30 years, median network size was 3 and 43.6% were female (Table 1). Participants lost to follow‐up were less likely than those who were retained to be unemployed, but were otherwise not different with respect to demographic characteristics [43]. As seen in Supporting information, Video S1 and Figure 1, the number of network members used to construct the network exposure variables increases over time.…”

Eliminating hepatitis C in a rural Appalachian county: protocol for the Kentucky Viral Hepatitis Treatment Study (KeY Treat), a phase IV, single-arm, open-label trial of sofosbuvir/velpatasvir for the treatment of hepatitis C

“…To date, 347 of the 503 participants in the rural PWUD cohort have tested HCV-antibody-positive (69.8% seroprevalence overall), 29 115 of which represent incident cases occurring in the past 10-12 years, primarily among young PWID; of those, approximately 70% are RNA-positive, 40 and are, therefore, eligible for hepatitis C treatment. However, data suggest low uptake of HCV treatment among PWUD and PWID in this region, 41 a lack of partner notification of HCV status 42 and social networks that facilitate continued transmission of the virus. 43 Among rural women in a local risk-reduction intervention, the prevalence of HCVantibody-positives was also high at 69% among PWID.…”