Geographic Differences in Hepatitis C Risk Profile Among People Who Inject Drugs - CHANGE presenting author

BACKGROUND:  Recent case studies and investigations have found increasing injection drug use and hepatitis C virus (HCV) transmission among young persons (under the age of 30) in a variety of United States rural and suburban settings.  A better understanding of the HCV risk profile by geographic setting would enable appropriate and targeted decisions regarding prevention strategies.  Therefore, the purpose of this analysis was to examine the HCV risk profile among people who inject drugs (PWID) in New York City (NYC) compared to Upstate NY.

METHODS: PWID were recruited through 16 syringe exchange programs throughout NY State (10 in NYC) using modified respondent driven sampling from June-December 2013.   Eligibility criteria included: injecting illicit drugs within the past 30 days and being at least 18 years old.  Target enrollment at each site was 50 individuals.  A face-to-face survey on demographics and injection behaviors was administered along with HCV rapid antibody testing.  Bivariate and multivariable analyses were conducted to assess for differences in HCV risk and positivity between NYC and Upstate NY.

RESULTS:  529 individuals were enrolled (70% in NYC); 472 received an HCV rapid test.  NYC respondents were significantly more likely to be male, non-Hispanic black, living in unstable housing, and injecting on a daily basis; they were significantly less likely to report being under the age of 30 sharing drug use equipment (cookers, cotton and water), sharing  needles, and having to “fish” for a vein (p-value < 0.05).  Overall, 57% of respondents were HCV reactive by rapid test (63% NYC compared to 41% Upstate; p-value: <0.0001).  NYC respondents were more likely to know their HCV status (79% in NYC compared to 52% in Upstate; p-value <0.0001).  The following associations remained significant in the multivariable modeling (adjusting for all other variables in the model): NYC respondents were more likely to report knowing their HCV status, being non-Hispanic black, and living in unstable housing; they were less likely to report being under the age of 30 and sharing drug use equipment.

CONCLUSIONS:  The HCV risk profile for PWID in NY differs by geography suggesting different prevention interventions are needed to address the needs of these divergent groups.   In this study, a higher percentage of respondents in NYC were positive compared to Upstate respondents, however, more were aware of their status which may play a role in injection behaviors.  Further analyses are needed to better understand this relationship.