Lack of Behavior Change After Disclosure of Hepatitis C Virus Infection Among Young Injection Drug Users in Baltimore, Maryland
October 3, 2002
Approximately 3.9 million residents of the United States are infected with hepatitis C virus (HCV). The prevalence of HCV is 65 percent to 90 percent among injection drug users (IDUs). Injection drug use accounts for over 60 percent of all HCV infections nationwide.
Previous studies have shown strong associations between acquisition of HCV infection and sharing of drug paraphernalia -- both "direct" sharing of needles and syringes and "indirect" sharing of cookers, cotton filters, and backloading -- the practice of preparing drugs from the barrel of one syringe and transferring them to another syringe. HCV transmission is also closely related to duration of injection drug use: among persons newly initiated into injection drug use in Baltimore, 65 percent had acquired HCV within 1 year of initiating injection behavior.
The authors of the current study sought to evaluate changes in high risk behaviors associated with HCV transmission through both "direct" and "indirect" sharing of injection paraphernalia after disclosure of a positive HCV antibody test. The study evaluated 60 IDUs through semi-annual interviews, HIV and HCV antibody testing and pre-test and post-test counseling. The authors also assessed changes in alcohol consumption among those with a positive HCV test result.
The study consisted of a post hoc analysis of data from the Risk Evaluation and Community Health (REACH) II Study -- a study of HIV risk among young, recently initiated IDUs in Baltimore. Participants included 226 IDUs enrolled in the REACH II Study between July 1997 and May 1999. Eligibility for the study included being 15-30 years old; having initiated injection drug use no more than 5 years prior to the study; and having injected illicit drugs at least once in the past 6 months. Informed consent was received from each participant.
Data collection included face-to-face interviews about demographic characteristics and high-risk behavior, as well as blood samples that were tested for HCV and for HIV. Questionnaires were used to determine demographic elements, risk behaviors and alcohol consumption during the previous 6 months. Follow-up evaluations were conducted 6 months after the baseline visit. Two weeks after baseline visit, participants returned for the results of their HIV and HCV tests and were given post-test counseling. In addition to counseling, participants were given the location and hours of operation of the Baltimore City Needle Exchange Program. Substance abuse treatment was discussed and referrals were provided. Those participants with HCV infection were counseled to avoid sharing needles, syringes and other equipment and they were referred to a counselor with expertise in HCV infection. Safe injection practices were encouraged. Some treatment options for HCV were offered but, at that time, were highly limited. Treatment for active drug use was not recommended.
Among the participants of the REACH II Study, the majority were African-American (61 percent) and female (64 percent). The mean age at enrollment was 26 years; age of first use of injection drugs was 23 years; and the median length of time using injection drugs was 2.1 years. The baseline prevalence of HCV and HIV infection were 60.5 percent and 10.6 percent, respectively; 7.7 percent of participants were coinfected with HCV and HIV. Baseline demographics were similar for both HCV-positive and non-HCV groups with respect to sex, age, homelessness, and alcohol dependence. At baseline, 43 percent of participants were alcohol dependent.
In the study of young IDUs who were seropositive for HCV and were informed of their serostatus, fewer than one-fifth of the study subjects had reductions in direct sharing of needles. Almost three-quarters of participants reported that they continued to practice backloading drugs. The pattern was especially apparent among HCV-infected subjects aware of their serostatus, of whom over 75 percent continued to backload. Over one-third continued to share needles.
According to the authors, the "...findings suggest that young IDUs may not be aware of the risk of HCV infection and highlight the urgent need for post-HCV test guidelines and behavioral interventions to reduce ongoing high-risk behavior that perpetuates the risk of HCV transmission."
Clinical Infectious Diseases
10.01.02; Vol. 35: P. 783-788; Danielle C. Ompad; Crystal M. Fuller; David Vlahov; David Thomas; Steffanie A. Strathdee
New Attitudes & Strategies: A Comprehensive Approach to Preventing Blood-Borne Infections Among IDUs
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.