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Gregory VL, Ofner S, Ellis RJ. O-Know Opioid Knowledge Test: Development and Psychometric Testing in a Community Setting. J Psychoactive Drugs 2024; 56:135-145. [PMID: 36409628 DOI: 10.1080/02791072.2022.2147883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/22/2022] [Accepted: 09/23/2022] [Indexed: 11/22/2022]
Abstract
Given the various sources and consequences of opioid use disorder (OUD) stigma, the mechanisms by which stigma occurs becomes more important. Educational deficits regarding OUD as a disease and treatment influence OUD stigma. The purpose of the study was to develop, pilot test and psychometrically evaluate the Opioid-Knowledge (O-Know) test in a community setting. A social media strategy was used to recruit 294 participants, in 2019, from a midwestern region experiencing an HIV epidemic, stemming from opioid and injection drug use. The Factor analysis used a tetrachoric correlation matrix, with principal axis factor extraction and Promax rotation. Horn's parallel analysis supported the factorial validity of a two-factor model representing OUD as a Disease (Cronbach's alpha = .57) and OUD Treatment and Recovery (Cronbach's alpha = .62). The reliability estimates were deemed adequate given the intended group-level uses for the instrument. Convergent construct validity was partially supported via the OUD Treatment and Recovery factor's negative correlation with personal opioid stigmatization (B = -.29, p =.001). OUD research must produce measures that convert observations to empirical generalizations. The psychometric analysis of the O-Know scale demonstrated progress in reducing measurement error to facilitate that conversion.
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Affiliation(s)
- Virgil L Gregory
- Indiana University School of Social Work, MSW Direct Indianapolis and United States United States
| | - Susan Ofner
- Indiana University School of Medicine and Richard M. Fairbanks School of Public Health Indianapolis United States
| | - Rebecca J Ellis
- Indiana University School of Nursing Indianapolis United States
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Methods for Assessing Spillover in Network-Based Studies of HIV/AIDS Prevention among People Who Use Drugs. Pathogens 2023; 12:pathogens12020326. [PMID: 36839598 PMCID: PMC9967280 DOI: 10.3390/pathogens12020326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 02/17/2023] Open
Abstract
Human Immunodeficiency Virus (HIV) interventions among people who use drugs (PWUD) often have spillover, also known as interference or dissemination, which occurs when one participant's exposure affects another participant's outcome. PWUD are often members of networks defined by social, sexual, and drug-use partnerships and their receipt of interventions can affect other members in their network. For example, HIV interventions with possible spillover include educational training about HIV risk reduction, pre-exposure prophylaxis, or treatment as prevention. In turn, intervention effects frequently depend on the network structure, and intervention coverage levels and spillover can occur even if not measured in a study, possibly resulting in an underestimation of intervention effects. Recent methodological approaches were developed to assess spillover in the context of network-based studies. This tutorial provides an overview of different study designs for network-based studies and related methodological approaches for assessing spillover in each design. We also provide an overview of other important methodological issues in network studies, including causal influence in networks and missing data. Finally, we highlight applications of different designs and methods from studies of PWUD and conclude with an illustrative example from the Transmission Reduction Intervention Project (TRIP) in Athens, Greece.
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Mateu-Gelabert P, Sabounchi NS, Guarino H, Ciervo C, Joseph K, Eckhardt BJ, Fong C, Kapadia SN, Huang TTK. Hepatitis C virus risk among young people who inject drugs. Front Public Health 2022; 10:835836. [PMID: 35968435 PMCID: PMC9372473 DOI: 10.3389/fpubh.2022.835836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Injection drug use (IDU) is the leading risk factor for hepatitis C virus (HCV) transmission in the U.S. While the general risk factors for HCV transmission are known, there is limited work on how these factors interact and impact young people who inject drugs (YPWID). Methods Project data were drawn from a study of 539 New York City (NYC) residents ages 18-29 who were recruited via Respondent-Driven Sampling and, reported past-month non-medical use of prescription opioids and/or heroin. Analyses are based on a subsample of 337 (62%) who reported injecting any drug in the past 12 months. All variables were assessed via self-report, except HCV status, which was established via rapid antibody testing. Integrating the observed statistical associations with extant literature on HCV risk, we also developed a qualitative system dynamics (SD) model to use as a supplemental data visualization tool to explore plausible pathways and interactions among key risk and protective factors for HCV. Results Results showed a 31% HCV antibody prevalence with an overall incidence of 10 per 100 person-years. HCV status was independently correlated with having shared cookers with two or more people (AOR = 2.17); injected drugs 4–6 years (AOR = 2.49) and 7 or more years (AOR = 4.95); lifetime homelessness (AOR = 2.52); and having been incarcerated two or more times (AOR = 1.99). These outcomes along with the extant literature on HCV risk were used to develop the qualitative SD model, which describes a causal hypothesis around non-linearities and feedback loop structures underlying the spread of HCV among YPWID. Conclusions Despite ongoing harm reduction efforts, close to a third of YPWID in the community sample have been exposed to HCV, have risks for injection drug use, and face challenges with structural factors that may be preventing adequate intervention. The qualitative SD model explores these issues and contributes to a better understanding of how these various risk factors interact and what policies could potentially be effective in reducing HCV infections.
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Affiliation(s)
- Pedro Mateu-Gelabert
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, United States
- *Correspondence: Pedro Mateu-Gelabert
| | - Nasim S. Sabounchi
- Department of Health Policy and Management, Center for Systems and Community Design (CSCD), CUNY Graduate School of Public Health and Health Policy, New York, NY, United States
| | - Honoria Guarino
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, United States
| | - Courtney Ciervo
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, United States
| | - Kellie Joseph
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, United States
| | | | - Chunki Fong
- Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, Institute for Implementation Science in Population Health (ISPH), New York, NY, United States
| | - Shashi N. Kapadia
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Terry T. K. Huang
- Department of Health Policy and Management, Center for Systems and Community Design (CSCD), CUNY Graduate School of Public Health and Health Policy, New York, NY, United States
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Yazdani K, Dolguikh K, Zhang W, Shayegi-Nik S, Ly J, Cooper S, Trigg J, Bartlett S, Barrios R, Montaner JSG, Salters K. Knowledge of hepatitis C and awareness of reinfection risk among people who successfully completed direct acting antiviral therapy. PLoS One 2022; 17:e0265811. [PMID: 35320316 PMCID: PMC8942206 DOI: 10.1371/journal.pone.0265811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
Abstract
Background Hepatitis C virus (HCV) education may be changing following the simplification of HCV treatment and emergence of direct acting antiviral (DAA). We aimed to characterize HCV knowledge among people who recently completed DAA therapy. Methods The Per-SVR (Preservation of Sustained Virologic Response) is a prospective cohort of patients who achieved a sustained virologic response upon successful completion of DAA therapy. The per-SVR study provided the sampling frame of participants who completed a psychometrically validated 19-item HCV knowledge scale at cohort entry (n = 227). To score the questionnaire, for each correct response one point was awarded, with no point for incorrect response. We assessed mean HCV knowledge score in the overall sample and mutually exclusive populations: people who inject drug (PWID) (n = 71); people with co-occurring HIV (n = 23); PWID and co-occurring HIV (n = 29), and others (n = 104) Using a latent class analysis based on distal outcome, we identified unobserved subgroups and assessed HCV knowledge amongst them. Results Total mean (SD) percent of correct responses were 83 (11) in the overall sample; 83 (10) in PWID; 79 (12) in people with co-occurring HIV; 81 (10) in PWID and co-occurring HIV, and 84 (11) in rest of the sample Three latent groups were identified: baby boomers who ever experienced homelessness (n = 126); women sex workers who ever experienced homelessness (n = 68); men who inject drug, ever experienced homelessness and had ever diagnosis of mental health disorders (n = 18). Mean percent of correct responses were 85 (8), 82 (11), 85 (10), in latent class 1, 2, and 3, respectively. Conclusion Patients successfully treated with DAAs had a high HCV knowledge. High knowledge and awareness of reinfection among complex patient groups often facing barriers to HCV care is encouraging and emphasizes the positive outcomes of universal access to treatment.
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Affiliation(s)
- Kiana Yazdani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Katerina Dolguikh
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Wendy Zhang
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sara Shayegi-Nik
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Experimental Medicine Program, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Jessica Ly
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Shaughna Cooper
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Sophia Bartlett
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | | | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- * E-mail:
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Opara I, Lardier DT, Durkee MI, Garcia-Reid P, Reid RJ. Ethnic Identity as a Moderator Between HIV Knowledge, Viral Hepatitis Knowledge, and Psychological Antecedents Among Racial-Ethnic Minority Youth Living in an Urban Community. J Racial Ethn Health Disparities 2021; 9:1298-1307. [PMID: 34041704 DOI: 10.1007/s40615-021-01069-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/27/2021] [Accepted: 05/18/2021] [Indexed: 11/25/2022]
Abstract
Racial-ethnic minority youth between the ages of 13 and 24 in the USA are disproportionately impacted by HIV. Low HIV knowledge and psychological antecedents such as low perception of risk and low sexual negotiation skills have all been associated with HIV risk behaviors; however, the role of ethnic identity on these factors is unclear in the literature. Ethnic identity, which is a critical part of identity development among racial-ethnic minority youth, has been found to be a protective factor in risk-taking behaviors. However, limited research is available on the role of ethnic identity in HIV prevention research among youth. For this study, data were collected as part of a larger HIV prevention education program using a sample of 564 students of color (Meanage = 16.30, standard deviation [SD] = 1.26; 67.4% Hispanic, 29.5% Black) from an underserved northeastern US urban community. We examined whether ethnic identity moderated the relationship between psychological antecedents (e.g., perception of risk and sexual negotiation skills), gender, and viral hepatitis knowledge on HIV knowledge. Findings revealed that ethnic identity significantly moderated the relationship between psychological antecedent variables and HIV knowledge by strengthening these associations as ethnic identity increased. Female adolescents were also more likely to have higher levels of HIV knowledge than males. Findings provide support for cultural and gender-specific prevention programs for racial-ethnic minority youth that seek to reduce HIV risk behaviors by increasing ethnic identity, particularly in under-resourced communities.
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Affiliation(s)
- Ijeoma Opara
- Department of Social and Behavioral Sciences, School of Public Health, Yale University, New Haven, CT, USA.
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, CT, USA.
| | - David T Lardier
- Department of Individual, Family, and Community Studies, University of New Mexico, Albuquerque, NM, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Myles I Durkee
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
| | - Robert J Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, NJ, USA
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Wirtz AL, Iyer JR, Brooks D, Hailey‐Fair K, Galai N, Beyrer C, Celentano D, Arrington‐Sanders R. An evaluation of assumptions underlying respondent-driven sampling and the social contexts of sexual and gender minority youth participating in HIV clinical trials in the United States. J Int AIDS Soc 2021; 24:e25694. [PMID: 33978326 PMCID: PMC8114466 DOI: 10.1002/jia2.25694] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Respondent-driven sampling (RDS) has been an effective sampling strategy for HIV research in many settings, but has had limited success among some youth in the United States. We evaluated a modified RDS approach for sampling Black and Latinx sexual and gender minority youth (BLSGMY) and explored how lived experiences and social contexts of BLSGMY youth may impact traditional RDS assumptions. METHODS RDS was implemented in three US cities, Baltimore, Philadelphia and Washington DC, to engage BLSGMY aged 15 to 24 years in HIV prevention or care intervention trials. RDS was modified to include targeted seed recruitment from venues, Internet and health clinics, and provided options for electronic or paper coupons. Qualitative interviews were conducted among a sub-sample of RDS participants to explore their experiences with RDS. Interviews were coded using RDS assumptions as an analytic framework. RESULTS Between August 2017 and October 2019, 405 participants were enrolled, 1670 coupons were distributed, with 133 returned, yielding a 0.079 return rate. The maximum recruitment depth was four waves among seeds that propagated. Self-reported median network size was 5 (IQR 2 to 10) and reduced to 3 (IQR 1 to 5) when asked how many peers were seen in the past 30 days. Qualitative interviews (n = 27) revealed that small social networks, peer trust and targeted referral of peers with certain characteristics challenged network, random recruitment, and reciprocity assumptions of RDS. HIV stigma and research hesitancy were barriers to participation and peer referral. Other situational factors, such as phone ownership and access to reliable transportation, reportedly created challenges for referred peers to participate in research. CONCLUSIONS Small social networks and varying relationships with peers among BLSGMY challenge assumptions that underlie traditional RDS. Modified RDS approaches, including those that incorporate social media, may support recruitment for community-based research but may challenge assumptions of reciprocal relationships. Research hesitancy and situational barriers are relevant and must be addressed across any sampling method and study design that includes BLSGMY in the United States.
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Affiliation(s)
- Andrea L. Wirtz
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Jessica R. Iyer
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Durryle Brooks
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Kimberly Hailey‐Fair
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Division of Adolescent and Young Adult MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
| | - Noya Galai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Chris Beyrer
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - David Celentano
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Renata Arrington‐Sanders
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Division of Adolescent and Young Adult MedicineJohns Hopkins School of MedicineBaltimoreMDUSA
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Kapadia SN, Katzman C, Fong C, Eckhardt BJ, Guarino H, Mateu-Gelabert P. Hepatitis C testing and treatment uptake among young people who use opioids in New York City: A cross-sectional study. J Viral Hepat 2021; 28:326-333. [PMID: 33141503 PMCID: PMC8207521 DOI: 10.1111/jvh.13437] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 09/22/2020] [Accepted: 10/23/2020] [Indexed: 12/16/2022]
Abstract
Young people who use drugs have a rising hepatitis C (HCV) incidence in the United States, but they may face barriers to testing and treatment adoption due to stigma. We conducted a cross-sectional study of New York City residents aged 18-29 years who reported non-medical prescription opioid and/or heroin use in the past 30 days. Participants were recruited from the community between 2014-2016 via respondent-driven sampling. Participants completed an in-person structured survey that included questions about HCV testing and treatment and received HCV antibody testing. There were 539 respondents: 353 people who inject drugs (PWID) and 186 non-PWID. For PWID, median age was 25 years, 65% were male and 73% non-Hispanic White. For non-PWID, median age was 23 years, 73% were male and 39% non-Hispanic White. 20% of PWID and 54% of non-PWID had never been tested for HCV (P < .001). Years since first injection (aOR 1.16, CI: 1.02-1.32, P = .02) and history of substance use treatment (aOR 3.17, CI: 1.53-6.61, P = .02) were associated with prior testing among PWID. The seroprevalence of HCV among PWID was 25%, adjusted for sampling weights. Of the 75 who were aware of their HCV-positive status, 53% had received HCV-related medical care, and 28% had initiated treatment. HCV prevalence among young PWID is high, and many have never been tested. Injection experience and treatment engagement is associated with testing. Interventions to increase testing earlier in injection careers, and to improve linkage to HCV treatment, will be critical for young PWID.
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Affiliation(s)
- Shashi N Kapadia
- Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Caroline Katzman
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Chunki Fong
- Institute for Implementation Science in Population Health, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Benjamin J Eckhardt
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Honoria Guarino
- Institute for Implementation Science in Population Health, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Pedro Mateu-Gelabert
- Department of Community Health and Social Sciences, City University of New York Graduate School of Public Health & Health Policy, New York, NY, USA
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Opara I, Lardier DT, Herrera A, Garcia-Reid P, Reid RJ. Increasing Viral Hepatitis Knowledge Among Urban Ethnic Minority Youth: Findings from a Community Based Prevention Intervention. J Community Health 2020; 45:269-277. [PMID: 31515664 PMCID: PMC7065932 DOI: 10.1007/s10900-019-00740-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Viral hepatitis (VH) knowledge among youth is understudied in the United States. There has been a rise in VH cases in the U.S. in the wake of the opioid epidemic. Innovative approaches to preventing the infection are needed especially in urban communities. This study presents preliminary findings from a community-based HIV/AIDS, substance abuse, and VH prevention education intervention for ethnic minority youth in a northeastern urban community. We aimed to evaluate VH knowledge and factors associated with knowledge. Participants in the study completed a baseline survey followed by an exit survey measuring VH knowledge after the intervention. The survey was completed by 691 individuals. Logistic regression analyses were conducted and indicated that there was a significant increase (82.3%) in VH knowledge among youth who participated in the intervention. The development and implementation of VH knowledge interventions can be crucial in alleviating the rise of VH infections in the U.S.
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Affiliation(s)
- Ijeoma Opara
- School of Social Welfare, Stony Brook University, Stony Brook, USA.
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, USA.
| | - David T Lardier
- Department of Individual, Family, and Community Studies, University of New Mexico, Albuquerque, USA
- Department of Psychiatry and Behavioral Sciences, University of New Mexico, Albuquerque, USA
| | - Andriana Herrera
- Department of Public Health, Montclair State University, Montclair, USA
| | - Pauline Garcia-Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, USA
| | - Robert J Reid
- Department of Family Science and Human Development, Montclair State University, Montclair, USA
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Katzman C, Mateu-Gelabert P, Kapadia SN, Eckhardt BJ. Contact tracing for hepatitis C: The case for novel screening strategies as we strive for viral elimination. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:33-39. [PMID: 31010750 PMCID: PMC6717536 DOI: 10.1016/j.drugpo.2019.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 01/07/2023]
Abstract
Contact tracing has been a key element of the public health response to infectious diseases for decades. These practices have been powerful in slowing the spread of tuberculosis, HIV, and other sexually transmitted infections. Despite success in other contexts, contact tracing for hepatitis C virus (HCV) has historically been considered infeasible because of a long asymptomatic period, which often makes it difficult to pinpoint the time of acquisition. Additionally, individuals may be reluctant to identify injecting partners because of stigma or fear of criminal repercussions. However, multiple factors - including the improved curability of HCV with advances in direct acting antiviral agents (DAAs), the implementation of age-based screening, and the current opioid epidemic -- have led to rapid changes in the landscape of HCV. HCV is increasingly concentrated among young people who inject drugs (PWID), many of whom are inadequately being reached by current screening practices. With the shift in the population most at risk for HCV and the fundamental changes in how we manage this disease, it's time to also rethink the public health response in identifying and informing those who may have been exposed. Contact tracing programs for HCV can augment existing screening strategies to provide curative treatment for patients and their partners, prevent reciprocal transmission of HCV between risk partners and within networks, and ultimately reach individuals who aren't yet engaged in healthcare and harm reduction. While there remain limitations to contact tracing for HCV, it has the potential to be a powerful tool in slowing the spread of the virus as we attempt to achieve viral elimination.
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