Attitudes, testing and treatment rates of hepatitis C and HIV among injection drug users

BACKGROUND: Injection drug users are at high risk for HIV and HCV, but historically have had less access to HCV evaluation and treatment. The Viral Hepatitis Integration Project (VHIP) seeks to establish/enhance hepatitis screening, testing, prevention and treatment within drug treatment and substance use settings already providing HIV services.

METHODS: Clients from methadone maintenance treatment programs and syringe exchange programs in New York City completed a baseline survey (n=1414) assessing their attitudes, beliefs, knowledge, experiences and risk behaviors.

RESULTS: The sample was predominately male (59%), >40 years old (66%) and Hispanic (65%). At baseline, just one-third of clients were vaccinated for hepatitis A or B. Furthermore, 73% and 98% had tested for HCV and HIV, respectively. Sixty percent of those tested were HCV-positive and 18% were HIV-positive. While 76% of HCV-positive clients had discussed treatment with a health care provider only 22% had a liver biopsy. Only 15% of HCV-positive clients were in treatment compared to 82% of HIV-positive clients. In contrast, clients expressed favorable attitudes towards hepatitis testing, vaccinations and treatment; 92% indicated they would get vaccinated and, among HCV-positive clients, the majority would get a liver biopsy and receive treatment.

CONCLUSIONS: Despite higher rates of HCV than HIV, hepatitis services are accessed at much lower rates than HIV services although clients have favorable attitudes toward hepatitis testing, vaccinations and treatment. Given this population's risky behavior, hepatitis vaccinations and HCV testing should be strongly encouraged as well as increasing access to HCV testing/treatment services. VHIP will address these inequities.