Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Office of Viral Hepatitis Prevention, Sexually Transmitted Diseases Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, 850 Marina Bay Parkway, Building P, 2nd Floor, Richmond, CA, 94804, USA.
BMC Public Health. 2021 Jul 21;21(1):1435. doi: 10.1186/s12889-021-11492-3.
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.
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.
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.
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.
2014 年至 2016 年间，加利福尼亚州 15-29 岁人群中新报告的丙型肝炎病毒 (HCV) 感染增加了 50%。国家估计表明，这一增长是由于阿片类药物流行以及相关的注射吸毒增加所致。然而，加利福尼亚州的 61 个地方卫生区 (LHJ) 中，大多数并未对新报告的 HCV 感染进行常规调查，因此这些人感染的风险因素并不清楚。我们试图描述加利福尼亚州新报告 HCV 感染的增长最快的年龄组人群的人口统计学特征、风险行为和减少伤害服务的利用情况，以支持针对 HCV 的预防和治疗策略。
加利福尼亚州公共卫生部邀请符合指示 HCV 感染人群风险升高标准的 LHJ 参与强化监测，如果他们符合指示 HCV 感染人群风险升高标准的话。2018 年 6 月至 12 月，8 个 LHJ 通过电话使用结构化问卷联系了新报告的 HCV 病例。
在符合纳入标准的 472 例 HCV 总病例中，有 114 例（24%）完成了访谈。27%的受访者（n=31）曾被监禁，其中 29%的人接受过纹身/穿孔，39%的人在监禁期间注射毒品。在注射毒品者（PWID）中——占所有受访者的 36%（n=41）——68%的人共用注射设备，许多人无法获得减少伤害服务：37%的人知道或曾经使用过针具交换，44%的人在过量用药时需要纳洛酮但没有。海洛因是最常报告的注射药物（n=30），其次是冰毒（n=18）。在 HCV 风险认知方面，诊断前的差异显著，PWID 组和非 PWID 组分别为 76%和 8%（p<0.001），非西班牙裔白人受访者和非西班牙裔白人受访者分别为 44%和 22%（p=0.011）。所有受访者中有 89%的人报告说有医疗保险，但只有两人接受过 HCV 抗病毒药物治疗。
在 HCV 年轻人中，我们发现诊断前 HCV 风险认知和获得减少伤害服务的机会有限，存在种族/民族差异。可能需要开展干预措施，提高年轻人中 PWID（尤其是有色人种年轻人）对减少伤害服务的认识、获取和利用。
