Disparities in risk perception and low harm reduction services awareness, access, and utilization among young people with newly reported hepatitis C infections in California, 2018

Abstract

Background Newly reported hepatitis C virus (HCV) infections in California increased 50% among people 15–29 years of age between 2014 and 2016. National estimates suggest this increase was due to the opioid epidemic and associated increases in injection drug use. However, most of California’s 61 local health jurisdictions (LHJs) do not routinely investigate newly reported HCV infections, so these individuals’ risk factors for infection are not well understood. We sought to describe the demographics, risk behaviors, and utilization of harm reduction services in California’s fastest-rising age group of people with newly reported hepatitis C infections to support targeted HCV prevention and treatment strategies. Methods California Department of Public Health invited LHJs to participate in enhanced surveillance if they met criteria indicating heightened population risk for HCV infection among people ages 15–29. From June–December 2018, eight LHJs contacted newly reported HCV cases by phone using a structured questionnaire. Results Among 472 total HCV cases who met the inclusion criteria, 114 (24%) completed an interview. Twenty-seven percent of respondents (n = 31) had ever been incarcerated, of whom 29% received a tattoo/piercing and 39% injected drugs while incarcerated. Among people who injected drugs (PWID)—36% (n = 41) of all respondents—68% shared injection equipment and many lacked access to harm reduction services: 37% knew of or ever used a needle exchange and 44% ever needed naloxone during an overdose but did not have it. Heroin was the most frequently reported injected drug (n = 30), followed by methamphetamine (n = 18). Pre-diagnosis HCV risk perception varied significantly by PWID status and race/ethnicity: 76% of PWID vs. 8% of non-PWID (p < 0.001), and 44% of non-Hispanic White respondents vs. 22% of people of color (POC) respondents (p = 0.011), reported thinking they were at risk for HCV before diagnosis. Eighty-nine percent of all respondents reported having health insurance, although only two had taken HCV antiviral medications. Conclusions Among young people with HCV, we found limited pre-diagnosis HCV risk perception and access to harm reduction services, with racial/ethnic disparities. Interventions to increase harm reduction services awareness, access, and utilization among young PWID, especially young PWID of color, may be warranted.

Intention to Screen for Hepatitis C Among University Students: Influence of Different Communicative Scenarios

“…A further strength of the study is the awareness-raising intervention for university students with no medical background. This age group is particularly exposed to experimentation, unruliness, promiscuity, and sometimes superficiality in assessing the medium- and long-term consequences of their actions ( 55 – 57 ).…”

HCV prevalence and phylogenetic characteristics in a cross‐sectional, community study of young people who inject drugs in New York City: Opportunity for and threats to HCV elimination

“… 41 It is important to note that a significant barrier to this strategy is the relatively low rate of SSP use among YPWID compared to older PWID, requiring further innovation in strategies to effectively reach and engage YPWID. 42 , 43 , 44 As suggested by Palmer et al, 45 future studies could incentivize referrals for engagement in testing and treatment. Despite this challenge, recent studies published by our group indicate that YPWID can successfully be treated at SSPs immediately after becoming aware of their active infection.…”

“…This initiative would entail offering low‐threshold, non‐stigmatizing HCV treatment to any young person who is HCV RNA‐positive at sites where infected individuals may already attend, such as SSPs 41 . It is important to note that a significant barrier to this strategy is the relatively low rate of SSP use among YPWID compared to older PWID, requiring further innovation in strategies to effectively reach and engage YPWID 42‐44 . As suggested by Palmer et al, 45 future studies could incentivize referrals for engagement in testing and treatment.…”

“…41 It is important to note that a significant barrier to this strategy is the relatively low rate of SSP use among YPWID compared to older PWID, requiring further innovation in strategies to effectively reach and engage YPWID. [42][43][44] As suggested by Palmer et al, 45 as older individuals are more likely to have a longer history of injection, and thus more opportunities for HCV exposure. 13,18 The findings for gender are also consistent with the literature, with females being marginally more likely to be HCV Ab positive compared to males.…”

The Impact of Racial Disparities on Liver Disease Access and Outcomes

“…However, there will still need to be intentional, culturally tailored efforts to reach the highest risk populations. In a California study examining HCV risk perceptions, there was a limited understanding of risk among people of color who inject drugs compared to their non-Hispanic White counterparts (22% vs. 44%, respectively) [20]. Additional studies employing community health worker delivered home-based screening programs, as modeled in a study that delivered home-based tests for HCV, HIV, and colorectal studies to women from Little Haiti (predominantly Haitian), Hialeah (predominantly Hispanic), and South-Dade (racially/ethnically mixed) women living in South Florida, can provide key information on the effectiveness of such programs for broader implementation [21].…”