The prevalence of hepatitis C among young people who use injection drugs is high. Further, many of these individuals have never been screened for the virus, researchers reported in the Journal of Viral Hepatitis.
Hep C is readily transmitted through shared syringes and other injection equipment, and is a growing problem among young people who use drugs. New hepatitis C virus (HCV) infections are now most common among people between ages 20 and 29. For this subgroup, stigma poses a barrier to testing and adherence to HCV therapy.
Shashi Kapadia, MD, of Weill Cornell Medicine, in New York City, and colleagues explored the status of hep C testing and treatment among young people who use injection drugs.
The team recruited 539 participants—353 people who used injection drugs and 186 people who did not use drugs—from New York City between 2014 and 2016. These individuals were between ages 18 and 29. Also, they had disclosed the use of a nonmedical prescription opioid and/or heroin during the previous 30 days.
The study population completed a 951-question survey that asked about socioeconomic status, mental health, substance use, hep C testing and treatment and other factors. They went on to get tested for antibodies to HCV.
The median age of those who used drugs was 25 years; a majority were male (65%) and white (73%). Among the 353 people who used injection drugs, 282 (80%) had been tested for hep C at some point in their lives, and 279 had been tested during the previous year. This group had been tested a median of three times. However, 20% of this group had never been tested for hep C.
The median age of those who did not use drugs was 23 years; a majority were male (73%) and only 39% were white. Among the 186 people who did not use injection drugs, 86 (46%) had been tested in their lifetime, and 84 had been tested in the previous year. This group had been tested a median of two times. But 54% had never been tested for hep C.
Among the entire study population, a total of 105 (20%) were found to be HCV positive, all of whom used injection drugs. Among those who injected drugs, 30% tested positive. After adjusting for sampling errors, the estimated prevalence was 18% for the population as a whole and 25% for those who injected drugs.
Of the 105 injection drug users who tested positive, 32 (30%) learned of their diagnosis through the study, while the remaining 73 had received a prior positive test. Further, among the 75 people who knew of their hep C status, 53% had received medical care for hep C, and 28% began treatment.
The researchers found that the time since first injection and history of substance use were linked to previous testing among those who injected drugs. Those who had a longer experience with injection drug use were more likely to have been tested for hep C. Receiving substance use treatment was also linked to a greater likelihood of receiving an HCV test. The researchers suggested that longer exposure to both drug injection and substance use programs was likely to result in more testing opportunities.
“Longer duration of injection experience and substance use treatment engagement are associated with testing, suggesting a need to improve our capacity to test those who have recently transitioned to injection and people who inject drugs who are not yet engaged with programs,” wrote the researchers.
Further, encouraging this population to receive hep C treatment may contribute to efforts to eliminate the disease. “Interventions to increase testing earlier in injection careers, and to improve linkage to HCV treatment, will be critical for young people who inject drugs,” they added.
Click here to read the study abstract in the Journal of Viral Hepatitis.
Click here to learn more about hep C.