Gonzalez Corro Luis A, Zook Katie, Landry Miles, Rosecrans Amanda, Harris Robert, Gaskin Darrell, Falade-Nwulia Oluwaseun, Page Kathleen R, Lucas Gregory M
Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Baltimore City Health Department, Baltimore, Maryland, USA.
Open Forum Infect Dis. 2024 Mar 2;11(4):ofae107. doi: 10.1093/ofid/ofae107. eCollection 2024 Apr.
Sixty-eight percent of the nearly 3.5 million people living with hepatitis C virus (HCV) in the United States are people who inject drugs (PWID). Despite effective treatments, uptake remains low in PWID. We examined the social determinants of health (SDoH) that affect the HCV care cascade.
We conducted a secondary analysis of data from 720 PWID in a cluster-randomized trial. We recruited PWID from 12 drug-affected areas in Baltimore. Inclusion criteria were injection in the prior month or needle sharing in the past 6 months. Intake data consisted of a survey and HCV testing. Focusing on SDoH, we analyzed self-report of (1) awareness of HCV infection (in those with active or previously cured HCV) and (2) prior HCV treatment (in the aware subgroup). We used descriptive statistics and logistic regression for statistical analyses.
The 342 participants were majority male and Black with a median age of 52 years. Women were more likely to be aware of their status but less likely to be treated. Having a primary care provider and HIV-positive status were associated with increased awareness and treatment. Unhoused people had 51% lower odds of HCV treatment. People who reported that other PWID had shared their HCV status with them had 2.3-fold higher odds of awareness of their own status.
Further study of gender disparities in HCV treatment access is needed. Increased social support was associated with higher odds of HCV treatment, suggesting an area for future interventions. Strategies to identify and address SDoH are needed to end HCV.
在美国近350万丙型肝炎病毒（HCV）感染者中，68%是注射吸毒者（PWID）。尽管有有效的治疗方法，但PWID中的治疗接受率仍然很低。我们研究了影响HCV治疗级联的健康社会决定因素（SDoH）。
我们对一项整群随机试验中720名PWID的数据进行了二次分析。我们从巴尔的摩12个受毒品影响的地区招募PWID。纳入标准是在前一个月有注射行为或在过去6个月内有共用针头行为。入组数据包括一项调查和HCV检测。聚焦于SDoH，我们分析了以下方面的自我报告：（1）HCV感染知晓情况（在现患或既往治愈HCV的人群中）以及（2）既往HCV治疗情况（在知晓亚组中）。我们使用描述性统计和逻辑回归进行统计分析。
342名参与者以男性和黑人为主，中位年龄为52岁。女性更有可能知晓自己的病情，但接受治疗的可能性较小。有初级保健提供者和HIV阳性状态与知晓率和治疗率的提高相关。无家可归者接受HCV治疗的几率低51%。报告称其他PWID与他们分享过HCV状态的人知晓自己状态的几率高2.3倍。
需要进一步研究HCV治疗可及性方面的性别差异。社会支持增加与HCV治疗几率较高相关，这表明是未来干预的一个领域。需要采取策略来识别和解决SDoH以消除HCV。
