Health System Innovation and Research Division, Population Health Sciences Department, School of Medicine, University of Utah, Salt Lake City, UT, United States of America.
Utah Department of Health, United States of America.
Prev Med. 2020 May;134:106040. doi: 10.1016/j.ypmed.2020.106040. Epub 2020 Feb 22.
After the 2014-2015 HIV outbreak in Scott County, Indiana, United States Centers for Disease Control and Prevention (CDC) conducted a nationwide analysis to identify vulnerable counties to an outbreak of Hepatitis C Virus (HCV)/Human Immunodeficiency Virus (HIV) and prevent such an outbreak in the future. We developed a jurisdiction-level vulnerability assessment for HCV infections associated with injection drug use (IDU) in Utah. We used three years of data (2015-2017) from 15 data sources to construct a regression model to identify significant indicators of IDU. A ZIP Code, county, or individual-level measure of IDU does not exist, therefore, CDC has suggested using HCV cases as a proxy for IDU. We used the Social Vulnerability Index to highlight vulnerable areas to HCV outbreaks and applied Geographical Information System (GIS) to identify hot spots of HCV infections (i.e. current/ongoing HCV transmissions). Rates of skin infection, buprenorphine prescription, administered naloxone, teen birth, and per capita income were associated with HCV infections. The opioid epidemic is dynamic and over time, it impacts different communities through its sequelae such as HCV outbreaks. We need to conduct this vulnerability assessment frequently, using updated data, to better target our resources. Moreover, we should consider evaluating whether the improvement of HCV screening has an impact on controlling HCV outbreaks. The analysis informs Utah's agencies and healthcare officials to target resources and interventions to prevent IDU-related HCV outbreaks. Our results inform policymakers at the national level on possible indicators of HCV outbreaks as well.
美国疾病控制与预防中心（CDC）在 2014-2015 年印第安纳州斯科特县发生 HIV 疫情后，进行了一项全国性分析，以确定易发生丙型肝炎病毒（HCV）/人类免疫缺陷病毒（HIV）疫情的脆弱县，并防止未来再次发生此类疫情。我们开发了犹他州与注射吸毒（IDU）相关的 HCV 感染的管辖级别脆弱性评估方法。我们使用了 15 个数据源的三年数据（2015-2017 年）来构建回归模型，以确定 IDU 的显著指标。不存在邮政编码、县或个人层面的 IDU 衡量标准，因此，CDC 建议使用 HCV 病例作为 IDU 的替代指标。我们使用社会脆弱性指数突出 HCV 疫情的脆弱地区，并应用地理信息系统（GIS）来识别 HCV 感染的热点（即当前/正在进行的 HCV 传播）。皮肤感染、丁丙诺啡处方、纳洛酮管理、青少年生育和人均收入与 HCV 感染有关。阿片类药物流行是动态的，随着时间的推移，它会通过 HCV 疫情等后果影响不同的社区。我们需要使用最新数据定期进行这种脆弱性评估，以更好地确定我们的资源目标。此外，我们应该考虑评估 HCV 筛查的改善是否对控制 HCV 疫情有影响。该分析为犹他州的机构和医疗保健官员提供了针对资源和干预措施的信息，以预防与 IDU 相关的 HCV 疫情。我们的结果还为国家层面的政策制定者提供了有关 HCV 疫情可能指标的信息。
