Differences in hepatitis C virus (HCV) testing and treatment by opioid, stimulant, and polysubstance use among people who use drugs in rural U.S. communities

Angela T. Estadt; David Kline; William C. Miller; Judith Feinberg; Christopher B. Hurt; L. Sarah Mixson; Peter D. Friedmann; Kelsa Lowe; Judith I. Tsui; April M. Young; Hannah Cooper; P. Todd Korthuis; Mai T. Pho; Wiley Jenkins; Ryan P. Westergaard; Vivian F. Go; Daniel Brook; Gordon Smith; Dylan R. Rice; Kathryn E. Lancaster

doi:10.1186/s12954-024-01131-6

Differences in hepatitis C virus (HCV) testing and treatment by opioid, stimulant, and polysubstance use among people who use drugs in rural U.S. communities

Angela T. Estadt, David Kline, William C. Miller, Judith Feinberg, Christopher B. Hurt, L. Sarah Mixson, Peter D. Friedmann, Kelsa Lowe, Judith I. Tsui, April M. Young, Hannah Cooper, P. Todd Korthuis, Mai T. Pho, Wiley Jenkins, Ryan P. Westergaard, Vivian F. Go, Daniel Brook, Gordon Smith, Dylan R. Rice, Kathryn E. Lancaster

Research output: Contribution to journal › Article › peer-review

Abstract

Background: People who use drugs (PWUD) in rural communities increasingly use stimulants, such as methamphetamine and cocaine, with opioids. We examined differences in hepatitis C virus (HCV) testing and treatment history among rural PWUD with opioids, stimulants, and other substance use combinations. Methods: PWUD were enrolled from ten rural U.S. communities from 2018 to 2020. Participants self-reporting a positive HCV result were asked about their HCV treatment history and drug use history. Drug use was categorized as opioids alone, stimulants alone, both, or other drug(s) within the past 30 days. Prevalence ratios (PR) were yielded using adjusted multivariable log-binomial regression with generalized linear mixed models. Results: Of the 2,705 PWUD, most reported both opioid and stimulant use (74%); while stimulant-only (12%), opioid-only (11%), and other drug use (2%) were less common. Most (76%) reported receiving HCV testing. Compared to other drug use, those who reported opioid use alone had a lower prevalence of HCV testing (aPR = 0.80; 95% CI: 0.63, 1.02). Among participants (n = 944) who self-reported an HCV diagnosis in their lifetime, 111 (12%) ever took anti-HCV medication; those who used both opioids and stimulants were less likely to have taken anti-HCV medication compared with other drug(s) (aPR = 0.41; 95% CI: 0.19, 0.91). Conclusions: In this pre-COVID study of U.S. rural PWUD, those who reported opioid use alone had a lower prevalence of reported HCV testing. Those diagnosed with HCV and reported both opioid and stimulant use were less likely to report ever taking anti-HCV medication.

Original language	English
Article number	214
Journal	Harm Reduction Journal
Volume	21
Issue number	1
DOIs	https://doi.org/10.1186/s12954-024-01131-6
State	Published - Dec 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Funding

This publication is based upon data collected and/or methods developed as part of the Rural Opioid Initiative (ROI), a multi-site study with a common protocol which was developed collaboratively by investigators at eight research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Research presented in this publication is the result of secondary data harmonization and analysis and supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UG3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by NIDA, ARC, CDC, and SAMHSA. The authors thank the other ROI investigators and their teams, the ROI Executive Steering Committee chair, Dr. Holly Hagan, the NIDA Science Officer, Dr. Richard Jenkins, and, particularly, the participants of the individual ROI studies for their valuable contributions. A full list of participating ROI investigators and institutions can be found on the ROI website at http://ruralopioidinitiative.org/studies.html . Additional funding for this publication includes NIDA F31DA054752 (ATE), NIDA K01DA048174 (KEL), NIDA R01DA052214 (DK and WCM), NIDA R01DA047334 and U54GM104942 (JF), NIDA F30DA050423 (DLB), and NCATS U01TR002631 (PTK).

Funders	Funder number
Centers for Disease Control and Prevention
Automotive Research and Testing Center
Appalachian Regional Commission
Rural Opioid Initiative
Substance Abuse and Mental Health Services Administration	U24DA048538
National Institute on Drug Abuse	UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044826/UH3DA044826, UG3DA044823/UH3DA044823, UG3DA044831/UH3DA044831, UG3DA044822/UH3DA044822, UG3DA044830/UH3DA044830, UG3DA044825, U24DA044801
National Center for Advancing Translational Sciences (NCATS)	U01TR002631

Keywords

HCV
Opioids
Polysubstance use
Rural
Stimulants

ASJC Scopus subject areas

Medicine (miscellaneous)
Public Health, Environmental and Occupational Health
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12954-024-01131-6

Cite this

Estadt, A. T., Kline, D., Miller, W. C., Feinberg, J., Hurt, C. B., Mixson, L. S., Friedmann, P. D., Lowe, K., Tsui, J. I., Young, A. M., Cooper, H., Korthuis, P. T., Pho, M. T., Jenkins, W., Westergaard, R. P., Go, V. F., Brook, D., Smith, G., Rice, D. R., & Lancaster, K. E. (2024). Differences in hepatitis C virus (HCV) testing and treatment by opioid, stimulant, and polysubstance use among people who use drugs in rural U.S. communities. Harm Reduction Journal, 21(1), Article 214. https://doi.org/10.1186/s12954-024-01131-6

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title = "Differences in hepatitis C virus (HCV) testing and treatment by opioid, stimulant, and polysubstance use among people who use drugs in rural U.S. communities",

abstract = "Background: People who use drugs (PWUD) in rural communities increasingly use stimulants, such as methamphetamine and cocaine, with opioids. We examined differences in hepatitis C virus (HCV) testing and treatment history among rural PWUD with opioids, stimulants, and other substance use combinations. Methods: PWUD were enrolled from ten rural U.S. communities from 2018 to 2020. Participants self-reporting a positive HCV result were asked about their HCV treatment history and drug use history. Drug use was categorized as opioids alone, stimulants alone, both, or other drug(s) within the past 30 days. Prevalence ratios (PR) were yielded using adjusted multivariable log-binomial regression with generalized linear mixed models. Results: Of the 2,705 PWUD, most reported both opioid and stimulant use (74\%); while stimulant-only (12\%), opioid-only (11\%), and other drug use (2\%) were less common. Most (76\%) reported receiving HCV testing. Compared to other drug use, those who reported opioid use alone had a lower prevalence of HCV testing (aPR = 0.80; 95\% CI: 0.63, 1.02). Among participants (n = 944) who self-reported an HCV diagnosis in their lifetime, 111 (12\%) ever took anti-HCV medication; those who used both opioids and stimulants were less likely to have taken anti-HCV medication compared with other drug(s) (aPR = 0.41; 95\% CI: 0.19, 0.91). Conclusions: In this pre-COVID study of U.S. rural PWUD, those who reported opioid use alone had a lower prevalence of reported HCV testing. Those diagnosed with HCV and reported both opioid and stimulant use were less likely to report ever taking anti-HCV medication.",

keywords = "HCV, Opioids, Polysubstance use, Rural, Stimulants",

author = "Estadt, \{Angela T.\} and David Kline and Miller, \{William C.\} and Judith Feinberg and Hurt, \{Christopher B.\} and Mixson, \{L. Sarah\} and Friedmann, \{Peter D.\} and Kelsa Lowe and Tsui, \{Judith I.\} and Young, \{April M.\} and Hannah Cooper and Korthuis, \{P. Todd\} and Pho, \{Mai T.\} and Wiley Jenkins and Westergaard, \{Ryan P.\} and Go, \{Vivian F.\} and Daniel Brook and Gordon Smith and Rice, \{Dylan R.\} and Lancaster, \{Kathryn E.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = dec,

doi = "10.1186/s12954-024-01131-6",

language = "English",

volume = "21",

number = "1",

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Estadt, AT, Kline, D, Miller, WC, Feinberg, J, Hurt, CB, Mixson, LS, Friedmann, PD, Lowe, K, Tsui, JI, Young, AM, Cooper, H, Korthuis, PT, Pho, MT, Jenkins, W, Westergaard, RP, Go, VF, Brook, D, Smith, G, Rice, DR & Lancaster, KE 2024, 'Differences in hepatitis C virus (HCV) testing and treatment by opioid, stimulant, and polysubstance use among people who use drugs in rural U.S. communities', Harm Reduction Journal, vol. 21, no. 1, 214. https://doi.org/10.1186/s12954-024-01131-6

TY - JOUR

T1 - Differences in hepatitis C virus (HCV) testing and treatment by opioid, stimulant, and polysubstance use among people who use drugs in rural U.S. communities

AU - Estadt, Angela T.

AU - Kline, David

AU - Miller, William C.

AU - Feinberg, Judith

AU - Hurt, Christopher B.

AU - Mixson, L. Sarah

AU - Friedmann, Peter D.

AU - Lowe, Kelsa

AU - Tsui, Judith I.

AU - Young, April M.

AU - Cooper, Hannah

AU - Korthuis, P. Todd

AU - Pho, Mai T.

AU - Jenkins, Wiley

AU - Westergaard, Ryan P.

AU - Go, Vivian F.

AU - Brook, Daniel

AU - Smith, Gordon

AU - Rice, Dylan R.

AU - Lancaster, Kathryn E.

PY - 2024/12

Y1 - 2024/12

N2 - Background: People who use drugs (PWUD) in rural communities increasingly use stimulants, such as methamphetamine and cocaine, with opioids. We examined differences in hepatitis C virus (HCV) testing and treatment history among rural PWUD with opioids, stimulants, and other substance use combinations. Methods: PWUD were enrolled from ten rural U.S. communities from 2018 to 2020. Participants self-reporting a positive HCV result were asked about their HCV treatment history and drug use history. Drug use was categorized as opioids alone, stimulants alone, both, or other drug(s) within the past 30 days. Prevalence ratios (PR) were yielded using adjusted multivariable log-binomial regression with generalized linear mixed models. Results: Of the 2,705 PWUD, most reported both opioid and stimulant use (74%); while stimulant-only (12%), opioid-only (11%), and other drug use (2%) were less common. Most (76%) reported receiving HCV testing. Compared to other drug use, those who reported opioid use alone had a lower prevalence of HCV testing (aPR = 0.80; 95% CI: 0.63, 1.02). Among participants (n = 944) who self-reported an HCV diagnosis in their lifetime, 111 (12%) ever took anti-HCV medication; those who used both opioids and stimulants were less likely to have taken anti-HCV medication compared with other drug(s) (aPR = 0.41; 95% CI: 0.19, 0.91). Conclusions: In this pre-COVID study of U.S. rural PWUD, those who reported opioid use alone had a lower prevalence of reported HCV testing. Those diagnosed with HCV and reported both opioid and stimulant use were less likely to report ever taking anti-HCV medication.

AB - Background: People who use drugs (PWUD) in rural communities increasingly use stimulants, such as methamphetamine and cocaine, with opioids. We examined differences in hepatitis C virus (HCV) testing and treatment history among rural PWUD with opioids, stimulants, and other substance use combinations. Methods: PWUD were enrolled from ten rural U.S. communities from 2018 to 2020. Participants self-reporting a positive HCV result were asked about their HCV treatment history and drug use history. Drug use was categorized as opioids alone, stimulants alone, both, or other drug(s) within the past 30 days. Prevalence ratios (PR) were yielded using adjusted multivariable log-binomial regression with generalized linear mixed models. Results: Of the 2,705 PWUD, most reported both opioid and stimulant use (74%); while stimulant-only (12%), opioid-only (11%), and other drug use (2%) were less common. Most (76%) reported receiving HCV testing. Compared to other drug use, those who reported opioid use alone had a lower prevalence of HCV testing (aPR = 0.80; 95% CI: 0.63, 1.02). Among participants (n = 944) who self-reported an HCV diagnosis in their lifetime, 111 (12%) ever took anti-HCV medication; those who used both opioids and stimulants were less likely to have taken anti-HCV medication compared with other drug(s) (aPR = 0.41; 95% CI: 0.19, 0.91). Conclusions: In this pre-COVID study of U.S. rural PWUD, those who reported opioid use alone had a lower prevalence of reported HCV testing. Those diagnosed with HCV and reported both opioid and stimulant use were less likely to report ever taking anti-HCV medication.

KW - HCV

KW - Opioids

KW - Polysubstance use

KW - Rural

KW - Stimulants

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U2 - 10.1186/s12954-024-01131-6

DO - 10.1186/s12954-024-01131-6

M3 - Article

C2 - 39614319

AN - SCOPUS:85211161429

SN - 1477-7517

VL - 21

JO - Harm Reduction Journal

JF - Harm Reduction Journal

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ER -

Differences in hepatitis C virus (HCV) testing and treatment by opioid, stimulant, and polysubstance use among people who use drugs in rural U.S. communities

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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