Online Program

Hepatitis C virus incidence and risk in suburbanites who inject drugs in southwestern Connecticut

Monday, November 2, 2015 : 11:10 a.m. - 11:30 a.m.

Robert Heimer, Ph D, Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
Lauretta E. Grau, Ph D, Department of Epidemiology and Public Health, Yale University, New Haven, CT
Samantha Batman, Yale School of Public Health and Geisel School Medicine at Dartmouth, Yale School of Public Health, New Haven, CT
The past two decades have witnessed increases in opioid abuse and injection drug use among non-urban populations, but the infectious disease consequences of this increase have been insufficiently explored. We conducted a longitudinal study of injectors who resided in non-urban towns in the suburban southwestern Connecticut. We used respondent-driven sampling to recruit and enroll individuals who could prove residence of at least six month in a suburban town and who injected drugs into a two-year longitudinal study. At enrollment and 6-month intervals thereafter survey data were collected on sociodemographics, drug use history and current injection practices, and locations (urban vs. suburban) of residence and where drugs were purchased and injected. Serological samples were collected and tested for HIV-1 hepatitis B virus (HBV) and hepatitis C virus (HCV) annually. All participants reported injecting opioids and 90% reported that heroin was the drug injected most. Unsafe injection in the month prior to the baseline interview was common. Syringe sharing was reported by 20% of respondents and other injection risks were reported by 18-35%. Although the prevalence of active HIV-1 and HBV infections was low (3.2% and 4.8%, respectively), HCV seroprevalence was 41%. Follow-up serological testing identified 11 incident HCV cases, 1 incident case of HBV, and 1 incident HIV case, yielding annual incident rates of 9.0% for HCV, 1.25% for HBV and 0.4% for HIV-1.  There was no discernable spatial clustering by residence for prevalent or incident cases and no significant association of infections with buying or injecting drug in urban locations despite the higher prevalence injection-related viruses in these cities. In conclusion, suburban injectors report a high level of injection risk and experienced a high HCV incident rate, HIV-1 and HBV incidence rates remained low, outcomes we attribute to low levels of these two viruses circulating in the suburban population

Learning Areas:

Protection of the public in relation to communicable diseases including prevention or control

Learning Objectives:
Identify HCV incident infections in a sample of people who inject drug and reside in suburbs in southwestern Connecticut during a two year longitudinal study Compare those already infected, those who became infected, and those who remained uninfected Formulate prevention and treatment strategies to reduce HCV incidence in this target group

Keyword(s): Drug Abuse, Hepatitis C

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was the principal investigator on the study. I have been conducting research on the syndemic of drug abuse, hepatitis, and HIV for more than two decades.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.