Theme: Epidemiology & Public Health Research Year: 2024
Background: The impact of knowledge of HCV+ status on high-risk behaviors among people who use drugs (PWUD) is unclear. We examined the prevalence of HCV infection and the relationship between perceived HCV status, high-risk behaviors, and engagement in care among PWUD in New Haven, Connecticut.
Methods: We analyzed New Haven site data from Project Needle EXchange Utilization Survey, a cross-sectional survey of PWUD recruited from syringe services programs (SSPs) in the US during 2021 to 2022 with concurrent HCV rapid antigen and RNA testing. We used univariate and multivariate analyses to determine the relationship between high-risk behaviors for HCV, perception of HCV status, and presumed protective and detrimental factors for HCV risk behaviors.
Results: 306 of 309 participants had HCV testing; 21% were HCV+ and 31% were previously infected. 46% had an inaccurate understanding of their HCV status. Perceived HCV status did not correlate significantly with utilization of used syringes or paraphernalia (48% current HCV+, 41% past HCV+, 36% HCV- respectively, p=0.22) nor with likelihood of giving syringes to others (30% current HCV+, 33% past HCV+, 29% HCV-, p=0.89). Engagement in HCV treatment, substance use disorder (SUD) treatment, and recent doctor visits were not associated with reduced high-risk behaviors. However, perceived SUD-related healthcare discrimination was associated with high-risk behaviors to self (OR 2.6, 95% CI 1.5-4.5, p=0.001) and others (OR 2.8, 95% CI 1.5-5.0, p=0.001), even after controlling for perceived HCV status.
Conclusion: Many PWUD utilizing the New Haven SSP had an inaccurate assessment of their HCV status. Individuals who experienced SUD-related healthcare discrimination had higher rates of high-risk behaviors, and these behaviors persisted among individuals who believed they had HCV and among those connected to HCV and SUD care. There may be missed opportunities for providers of HCV and SUD care to identify and support harm reducing behaviors among HCV+ patients.
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