Pedro Mateu-Gelabert, Seanna Pratt, Honoria Guarino, Renee Hallack, Chunki Fong, Ben Eckhardt
CUNY Graduate School of Public Health and Health Policy New York City New York USA.
NYS Department of Health Wadsworth Center Albany New York USA.
Health Sci Rep. 2024 Jul 1;7(7):e2211. doi: 10.1002/hsr2.2211. eCollection 2024 Jul.
In the United States, the opioid epidemic has led many young people who use opioids to initiate injection drug use, putting them at risk for hepatitis C virus (HCV) infection. However, community surveys to monitor HCV prevalence among young people who inject drugs (YPWID) are rare.
As part of Staying Safe (Ssafe), a trial to evaluate an HCV-prevention intervention, a community-recruited sample of 439 young people who use opioids (ages 18-30) in New York City (NYC) were screened from 2018 to 2021. Screening procedures included a brief verbal questionnaire, a visual check for injection marks, onsite urine drug testing, rapid HCV antibody (Ab) testing, and dried blood spot (DBS) collection. DBS specimens were sent to a laboratory for HCV RNA testing and phylogenetic analysis to identify genetic linkages among HCV RNA-positive specimens. Multivariable logistic regression was used to assess associations between HCV status (Ab and RNA) and demographics and drug use patterns.
Among the 330 participants who reported injecting drugs (past 6 months), 33% ( = 110) tested HCV Ab-positive, 58% of whom ( = 64) had HCV RNA-positive DBS specimens, indicating active infection. In multivariable analysis, visible injection marks (AOR = 3.02; < 0.001), older age (AOR = 1.38; < 0.05), and female gender (AOR = 1.69; = 0.052) were associated with HCV Ab-positive status. Visible injection marks were also associated with HCV RNA-positive status (AOR = 5.24; < 0.01). Twenty-five percent of RNA-positive specimens (14/57) were genetically linked.
The relatively low prevalence of active infection suggests the potential impact of treatment-as-prevention in reducing HCV prevalence among YPWID. Targeted community serosurveys could help identify actively infected YPWID for treatment, thereby reducing HCV incidence and future transmissions.
在美国，阿片类药物泛滥致使许多使用阿片类药物的年轻人开始注射吸毒，这使他们面临感染丙型肝炎病毒（HCV）的风险。然而，针对注射吸毒的年轻人（YPWID）中HCV流行情况进行监测的社区调查却很罕见。
作为一项评估HCV预防干预措施的试验“保持安全（Ssafe）”的一部分，2018年至2021年期间，从纽约市（NYC）社区招募了439名使用阿片类药物的年轻人（年龄在18 - 30岁之间）进行筛查。筛查程序包括一份简短的口头问卷、对注射痕迹的目视检查、现场尿液药物检测、快速HCV抗体（Ab）检测以及干血斑（DBS）采集。将DBS标本送至实验室进行HCV RNA检测和系统发育分析，以确定HCV RNA阳性标本之间的基因联系。采用多变量逻辑回归分析来评估HCV状态（Ab和RNA）与人口统计学特征及药物使用模式之间的关联。
在报告有注射吸毒行为（过去6个月内）的330名参与者中，33%（n = 110）检测出HCV Ab阳性，其中58%（n = 64）的干血斑标本HCV RNA呈阳性，表明存在活动性感染。在多变量分析中，可见的注射痕迹（调整后比值比[AOR] = 3.02；P < 0.001）、年龄较大（AOR = 1.38；P < 0.05）以及女性（AOR = 1.69；P = 0.052）与HCV Ab阳性状态相关。可见的注射痕迹也与HCV RNA阳性状态相关（AOR = 5.24；P < 0.01）。25%的RNA阳性标本（14/57）存在基因联系。
活动性感染的相对低流行率表明预防治疗在降低YPWID中HCV流行率方面的潜在影响。有针对性的社区血清学调查有助于识别出需要治疗的活动性感染YPWID，从而降低HCV发病率和未来传播风险。
