Injection behaviors among injection drug users in treatment: The role of hepatitis C awareness.
Injection drug use (IDU) is a primary vector for blood-borne infections. Awareness of Hepatitis C virus (HCV) infection status may affect risky injection behaviors. This study determines the prevalence of risky injection practices and examines associations between awareness of positive HCV status and risky injection behaviors. In this study, part of protocol CTN-0012, a national HIV screening trial, individuals seeking treatment for substance abuse at 12 community treatment programs were surveyed. Participants reported socio-demographic characteristics, substance use, risk behaviors, and HCV status. Researchers used multivariable logistic regression to test associations between participant characteristics and syringe/needle sharing. The 1281 participants included 244 (19%) individuals who reported injecting drugs in the past 6 months and 37.7% of IDUs reported being HCV positive. During the six months preceding baseline assessment, the majority of IDUs reported obtaining sterile syringes from pharmacies (51.6%) or syringe exchange programs (25%), but fewer than half of IDUs always used a sterile syringe (46.9%). More than one-third (38.5%) shared syringe/needles with another injector in the past 6 months. Awareness of positive HCV vs. negative/unknown status was associated with increased recent syringe/needle sharing (aOR 2.37, 95% CI 1.15, 4.88) in multivariable analysis.
Conclusions: Risky injection behaviors remain prevalent and awareness of HCV infection was associated with increased risky injection behaviors. This study highlights the need for broadly implemented HCV prevention interventions for all IDUs seeking addiction treatment, and suggests such interventions might particularly decrease transmission behaviors of those aware of their HCV infection and prevent HCV infections in those HCV-negative/unaware. As HCV screening and treatment options advance, community based treatment programs have a greater opportunity to play a central role in reducing HCV transmissions and engaging HCV-infected IDUs in treatment.
Related protocols: CTN-0012