High-Risk Injection-Related Practices Associated with HCV Infection Among Suburban Young Adults in Wisconsin

Background: Hepatitis C virus (HCV) infection has been increasing in recent years, particularly among people who inject drugs (PWID), younger than age 30 years, and living in rural or suburban areas. In Wisconsin, rates of acute HCV infection increased from 0.1 cases/100,000 in 2008 to 0.9 cases/100,000 in 2015, a trend significantly higher than the national average. We examined the injection-related behaviors of young PWID in three areas of suburban Wisconsin to determine factors associated with the high rates of HCV infection.

Methods: Respondent-driven sampling was used to recruit young adult PWID ages 18 to 29 years who reported injection drug use (IDU) in the previous 12 months. Recruitment took place from three suburban sites in Wisconsin (Kenosha, Green Bay and Eau Claire) from September 2013 to May 2015. Participants responded to questions regarding demographic characteristics and high-risk injection-related behaviors and practices via a self-administered computer-based survey. All participants were tested for HCV antibody (anti-HCV). We measured anti-HCV prevalence and compared factors associated with presence of anti-HCV using multivariate logistic regression.

Results: Of 280 participants, 117 (42%) were male, 231 (83%) were white, and the median age was 23 years. Overall HCV seroprevalence was 33% (n=93); of those 46% were male (n=46) and 29% were female (n=47). Adjusting for demographic characteristics, anti-HCV positivity was associated with older participant age (24-29 years compared to 18-23 years) (aOR= 2.53; 95% confidence interval [CI]: 1.37-4.68), higher injection frequency (more than 100 times in the past six months compared to less than 100 times in the past six months) (aOR=3.16; 95% CI: 1.79-5.57), ever shared syringes (aOR=4.83; 95% CI: 2.42-9.63), use of larger barrel needles (aOR=2.40; 95% CI: 1.12-5.14), reusing syringes (aOR 2.68, 95% CI: 1.16, 6.21), sharing rinse water (aOR=1.77; 95% CI: 1.01-3.10), or filters (aOR=3.14; 95% CI: 1.59-6.22), and history of overdose (aOR=2.25; 95% CI: 1.39-3.92).

Discussion: Anti-HCV positivity is associated with high-risk injection practices, including sharing injection equipment and frequency of injection, as well as a history of overdose. Young PWID from these rural and suburban parts of Wisconsin would benefit from evidence-based interventions that reduce their risk of infection, including medication-assisted drug treatment, and syringe services programs. For those HCV-infected, linkage to HCV care and treatment and/or education regarding safe injection may reduce the risk of further transmission. Public health policies would be helpful in improving access to such interventions among suburban and rural PWID.