Hepatitis C knowledge among new injection drug users

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

OBJECTIVE

To conduct a literature review about the breadth of risks for acquiring hepatitis C virus (HCV) among women who are living in the United States.

DESIGN

A mixed research synthesis of qualitative, quantitative, and mixed-methods studies guided by the Socioecological Model and Theory of Gender and Power.

SAMPLE AND ANALYTIC STRATEGY

The sample consisted of 29 studies: 10 qualitative, 18 quantitative, and one mixed-methods studies. Data were analyzed using a segregated approach and integrated into a narrative synthesis of themes by components of the Socioecological Model.

RESULTS

Individual risks themes were drug use as a coping strategy, transition to injection drug use, and lack of awareness about HCV. Interpersonal risks themes were social norms of drug use and drug use and sexual activities. Community risks themes were community re-entry, housing instability, and community HCV resources. Societal risks themes are policies affecting drug markets and social construct of "worthlessness."

CONCLUSIONS

Findings highlight the need for comprehensive gender-specific HCV prevention strategies built around harm reduction. In partnership with women with lived experience, public health nurses can apply findings to build harm reduction collaborations aimed at implementing HCV risk-reduction or risk-elimination strategies.

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

BACKGROUND

Hepatitis C virus (HCV) incidence has increased dramatically in the United States in recent years and is associated with the opioid epidemic due to high HCV transmission risk among people who inject drugs (PWID). HCV transmission knowledge is difficult to ascertain given the lack of psychometrically-tested measures. We developed and validated an HCV injection-risk knowledge scale.

METHODS

Analyses used data from 539 New York City opioid users ages 18-29 recruited via respondent-driven sampling in 2014-16. Blood samples yielded HCV antibody status. Principal components analysis (PCA) of nine knowledge items answered true, false, or don't know identified useful scale items. We evaluated internal consistency with the Cronbach's alpha coefficient and assessed construct validity by comparing knowledge levels with those from a previously validated general HCV knowledge scale and by comparing key sub-group knowledge levels.

RESULTS

PCA identified one component with five items that explained 45% of the total variance and had high internal consistency (alpha=0.91). All items referred to transmission through drug-injection equipment and practices: sharing cookers, cottons, diluting water, water containers, and cleaning syringes with water. The mean percent correct was 75%, and as expected, was moderately correlated with general HCV knowledge (Spearman's rho=0.55). As hypothesized, knowledge levels were highest for those previously tested for HCV, those with HCV antibody-positive status, PWID, and those who had received harm reduction information in various settings.

CONCLUSIONS

The 5-item, validated HCV Injection-Risk Knowledge Scale (HCV-IRKS) may provide educators, care providers, and researchers with critical information for reducing HCV among PWID.

HCV knowledge among a sample of HCV positive Aboriginal Australians residing in New South Wales

Australian Aboriginal and Torres Strait Islanders are overrepresented in both the prevalence and incidence of the hepatitis C (HCV). HCV knowledge has been associated with a range of positive health behaviours. HCV knowledge has previously been investigated as a single construct; however examining different knowledge domains (i.e. transmission, risk of complications, testing and treatment) separately may be beneficial. This study investigated whether having greater HCV knowledge in different domains is associated with self-reported positive health behaviours. 203 Aboriginal people living with HCV completed a survey assessing HCV knowledge, testing and care, lifestyle changes since diagnosis and treatment intent. Respondents' knowledge was relatively high. Greater knowledge of risk of health complications was associated with undertaking more positive lifestyle changes since diagnosis. Respondents testing and treatment knowledge was significantly associated with incarceration, lifestyle changes since diagnosis and future treatment intentions. This study illustrates the importance of ensuring that knowledge is high across different HCV domains to optimise a range of positive health behaviours of Aboriginal people living with HCV. Future health promotion campaigns targeted at Aboriginal people living with HCV could benefit from broadening their focus from prevention to other domains such as testing and treatment.

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

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. [Grau LB, Zhan W, Heimer R. Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut. Drug Alcohol Rev 2016;35:628-636].

Hepatitis C avoidance in injection drug users: a typology of possible protective practices

Introduction

Hepatitis C virus (HCV) represents a serious public health concern. People who inject drugs (PWID) are at particular risk and nearly half (45%) of PWID in England may be infected. HCV prevention interventions have only had moderate impact on the prevalence of HCV in this population. Using qualitative methods, we sought to detail the protective practices potentially linked to HCV avoidance among PWID, and explore the motivations for these.

Methods

The study used a life history approach allowing participants to detail their lived experience both before and during the course of their injecting careers. Thirty-seven participants were recruited from drug services in London, and from referrals within local injecting networks. A baseline and follow-up in-depth qualitative interview was carried out with each participant, and for half, a third interview was also undertaken. All underwent testing for HCV antibody. Analyses focused on developing a descriptive typology of protective practices potentially linked to HCV avoidance.

Results

Practices were deemed to be protective against HCV if they could be expected a priori to reduce the number of overall injections and/or the number of injections using shared injecting equipment. Participants reported engaging in various protective practices which fell into three categories identified through thematic analysis: principles about injecting, preparedness, and flexibility.

Conclusions

All participants engaged in protective practices irrespective of serostatus. It is important to consider the relative importance of different motivations framing protective practices in order to formulate harm reduction interventions which appeal to the situated concerns of PWID, especially given that these protective practices may also help protect against HIV and other blood borne infections.

Accelerated transition to injection among male heroin initiates in Hanoi, Vietnam: implications for early harm reduction interventions

This paper examines changes in the interval between first heroin smoking and onset of injection in a large, out-treatment sample of male heroin users in Hanoi, Vietnam (n = 1,115). Mean age at initiation of heroin use (smoking) was 18.4 and mean age of onset of heroin injection was 20.9 years. Full multivariate analysis indicates that the interval between first heroin use (smoking) and first heroin injection has been significantly attenuated among more recent heroin initiates (P = 0.0043), suggesting that heroin users in Vietnam may be at increased risk for exposure to HIV relatively soon after onset of heroin use, highlighting the need for behavioral interventions that target heroin smokers. Critical intervention goals include delaying the onset of injection and improved education about safer drug sharing and drug injection practices.