Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA.
Harm Reduct J. 2024 Jan 28;21(1):23. doi: 10.1186/s12954-023-00916-5.
BACKGROUND: Hepatitis C virus (HCV) disproportionately affects rural communities, where health services are geographically dispersed. It remains unknown whether proximity to a syringe services program (SSP) is associated with HCV infection among rural people who inject drugs (PWID). METHODS: Data are from a cross-sectional sample of adults who reported injecting drugs in the past 30 days recruited from rural counties in New Hampshire, Vermont, and Massachusetts (2018-2019). We calculated the road network distance between each participant's address and the nearest fixed-site SSP, categorized as ≤ 1 mile, 1-3 miles, 3-10 miles, and > 10 miles. Staff performed HCV antibody tests and a survey assessed past 30-day injection equipment sharing practices: borrowing used syringes, borrowing other used injection equipment, and backloading. Mixed effects modified Poisson regression estimated prevalence ratios (aPR) and 95% confidence intervals (95% CI). Analyses were also stratified by means of transportation. RESULTS: Among 330 PWID, 25% lived ≤ 1 mile of the nearest SSP, 17% lived 1-3 miles of an SSP, 12% lived 3-10 miles of an SSP, and 46% lived > 10 miles from an SSP. In multivariable models, compared to PWID who lived within 1 mile of an SSP, those who lived 3 to 10 miles away had a higher prevalence of HCV seropositivity (aPR: 1.25, 95% CI 1.06-1.46), borrowing other used injection equipment (aPR: 1.23, 95% CI 1.04-1.46), and backloading (aPR: 1.48, 95% CI 1.17-1.88). Similar results were observed for PWID living > 10 miles from an SSP: aPR [HCV]: 1.19, 95% CI 1.01-1.40; aPR [borrowing other used equipment]:1.45, 95% CI 1.29-1.63; and aPR [backloading]: 1.59, 95% CI 1.13-2.24. Associations between living 1 to 3 miles of an SSP and each outcome did not reach statistical significance. When stratified by means of transportation, associations between distance to SSP and each outcome (except borrowing other used injection equipment) were only observed among PWID who traveled by other means (versus traveled by automobile). CONCLUSIONS: Among PWID in rural New England, living farther from a fixed-site SSP was associated with a higher prevalence of HCV seropositivity, borrowing other used injection equipment, and backloading, reinforcing the need to increase SSP accessibility in rural areas. Means of transportation may modify this relationship.
背景：丙型肝炎病毒（HCV）在农村社区的发病率过高，而这些地区的卫生服务分布不均。目前尚不清楚，在农村地区注射毒品者（PWID）中，接近注射器具服务项目（SSP）是否与 HCV 感染有关。
方法：本研究数据来自新罕布什尔州、佛蒙特州和马萨诸塞州农村县招募的在过去 30 天内报告过吸毒的成年人的横断面样本（2018-2019 年）。我们计算了每个参与者地址与最近的固定地点 SSP 之间的路网距离，分为≤1 英里、1-3 英里、3-10 英里和＞10 英里。工作人员进行 HCV 抗体检测，同时评估参与者过去 30 天内的注射设备共享行为：借用使用过的注射器、借用其他使用过的注射设备和回装。混合效应修正泊松回归估计了患病率比（aPR）和 95%置信区间（95%CI）。分析还按交通方式进行了分层。
结果：在 330 名 PWID 中，25%的人居住在距离最近的 SSP 不到 1 英里的地方，17%的人居住在 1-3 英里的地方，12%的人居住在 3-10 英里的地方，46%的人居住在距离 SSP 超过 10 英里的地方。在多变量模型中，与居住在 1 英里以内的 SSP 的 PWID 相比，居住在 3 至 10 英里范围内的 PWID HCV 血清阳性率更高（aPR：1.25，95%CI 1.06-1.46），借用其他使用过的注射设备（aPR：1.23，95%CI 1.04-1.46）和回装（aPR：1.48，95%CI 1.17-1.88）。对于居住在距离 SSP 超过 10 英里的 PWID，也观察到类似的结果：HCV 的 aPR [aPR]：1.19，95%CI 1.01-1.40；借用其他使用过的设备的 aPR [aPR]：1.45，95%CI 1.29-1.63；回装的 aPR [aPR]：1.59，95%CI 1.13-2.24。居住在 1 至 3 英里范围内与每个结果之间的关联没有达到统计学意义。按交通方式分层时，与 SSP 距离与每个结果（借用其他使用过的注射设备除外）之间的关联仅见于使用其他交通工具（而非汽车）的 PWID 中。
结论：在新英格兰农村地区的 PWID 中，距离固定地点 SSP 越远，HCV 血清阳性率、借用其他使用过的注射设备和回装的比例越高，这突显了在农村地区增加 SSP 可及性的必要性。交通方式可能会改变这种关系。
Drug Alcohol Depend. 2020-12-1
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