Skip to main content

Advertisement

SpringerLink
Log in

Unmet Health Care Needs and Hepatitis C Infection Among Persons Who Inject Drugs in Denver and Seattle, 2009

  • Published:
Prevention Science Aims and scope Submit manuscript

Abstract

Persons who inject drugs (PWID) shoulder the greater part of the hepatitis C virus (HCV) epidemic in the USA. PWID are also disproportionately affected by limited access to health care and preventative services. We sought to compare current health care coverage, HCV, and HIV testing history, hepatitis A and B vaccination coverage, and co-occurring substance use among PWID in two US cities with similar estimated numbers of PWID. Using data from the 2009 National HIV Behavioral Surveillance system in Denver (n = 428) and Seattle (n = 507), we compared HCV seroprevalence and health care needs among PWID. Overall, 73 % of participants who tested for HCV antibody were positive. Among those who were HCV antibody-positive, vaccination coverage for hepatitis A and B was low (43 % in Denver and 34 % in Seattle) and did not differ significantly from those who were antibody-negative. Similarly, participation in alcohol or drug treatment programs during the preceding 12 months was not significantly higher among those who were HCV antibody-positive in either city. Significantly fewer participants in Denver had health care coverage compared to Seattle participants (45 vs. 67 %, p < 0.001). However, more participants in Seattle reported being disabled for work and, thus, more likely to be receiving health care coverage through the federal Medicaid program. In both cities, the vast majority of those who were aware of their HCV infection reported not receiving treatment (90 % in Denver and 86 % in Seattle). Our findings underscore the need to expand health care coverage and preventative medical services for PWID. Furthermore, our findings point to the need to develop comprehensive and coordinated care programs for infected individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • Aceijas, C., & Rhodes, T. (2007). Global estimates of prevalence of HCV infection among injecting drug users. The International Journal on Drug Policy, 18, 352–358.

    Article  PubMed  Google Scholar 

  • Alter, M. J., Kuhnert, W. L., & Finelli, L. (2003). Guidelines for laboratory testing and result reporting of antibody to hepatitis C virus. Centers for Disease Control and Prevention. MMWR Recommendations and Reports, 52, 1–13.

    PubMed  Google Scholar 

  • Amon, J. J., Garfein, R. S., Ahdieh-Grant, L., Armstrong, G. L., Ouellet, L. J., Latka, M. H., et al. (2008). Prevalence of hepatitis C virus infection among injection drug users in the United States, 1994–2004. Clinical Infectious Diseases, 46, 1852–1858.

    Article  PubMed  Google Scholar 

  • Appel, P. W., Ellison, A. A., Jansky, H. K., & Oldak, R. (2004). Barriers to enrollment in drug abuse treatment and suggestions for reducing them: Opinions of drug injecting street outreach clients and other system stakeholders. The American Journal of Drug and Alcohol Abuse, 30, 129–153.

    Article  PubMed  Google Scholar 

  • Armstrong, G. L., Wasley, A., Simard, E. P., McQuillan, G. M., Kuhnert, W. L., & Alter, M. J. (2006). The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Annals of Internal Medicine, 144, 705–714.

    Article  PubMed  Google Scholar 

  • Baars, J., Boon, B., De Wit, J. B., Schutten, M., Van Steenbergen, J. E., Garretsen, H. F., et al. (2008). Drug users’ participation in a free hepatitis B vaccination program: Demographic, behavioral, and social-cognitive determinants. Substance Use & Misuse, 43, 2145–2162.

    Article  Google Scholar 

  • Brady, J. E., Friedman, S. R., Cooper, H. L., Flom, P. L., Tempalski, B., & Gostnell, K. (2008). Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from 1992 to 2002. Journal of Urban Health, 85, 323–351.

    Article  PubMed Central  PubMed  Google Scholar 

  • Burr, C. K., Storm, D. S., Hoyt, M. J., Dutton, L., Allread, V., et al. (2014). Integrating health and prevention services in syringe access programs: A strategy to address unmet needs in a high-risk population. Public Health Reports, 129, 26–32.

    PubMed Central  PubMed  Google Scholar 

  • Campbell, J. V., Garfein, R. S., Thiede, J., Hagan, H., Ouellet, L. J., Golub, E. T., et al. (2007). Convenience is the key to hepatitis A and B vaccination uptake among young adult injection drug users. Drug and Alcohol Dependence, 91, S64–S72.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2006). Hepatitis B vaccination coverage among adults–United States, 2004. MMWR Weekly Report, 55, 509–511.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2012a). Integrated prevention services for HIV infection, viral hepatitis, sexually transmitted diseases, and tuberculosis for persons who use drugs illicitly: Summary guidance from CDC and the U.S. Department of Health and Human Services. MMWR Recommendations and Reports, 61, 1–40.

    Google Scholar 

  • Centers for Disease Control and Prevention. (2012b). HIV infection and HIV-associated behaviors among injecting drug users—20 cities, United States, 2009. MMWR Weekly Report, 61, 133–138.

    Google Scholar 

  • Chitwood, D. D., Comerford, M., & McCoy, H. V. (2002). Satisfaction with access to health care among injection drug users, other drug users, and nonusers. The Journal of Behavioral Health Services & Research, 29, 189–197.

    Article  Google Scholar 

  • Chitwood, D. D., McBride, D. C., French, M. T., & Comerford, M. (1999). Health care need and utilization: A preliminary comparison of injection drug users, other illicit drug users, and nonusers. Substance Use and Misuse, 34, 727–746.

    Article  CAS  PubMed  Google Scholar 

  • Cronquist, A., Edwards, V., Galea, S., Latka, M., & Vlahov, D. (2001). Health care utilization among young adult injection drug users in Harlem, New York. Journal of Substance Abuse, 13, 17–27.

    Article  CAS  PubMed  Google Scholar 

  • Des Jarlais, D. C., Fisher, D. G., Newman, J. C., Trubatch, B. N., Yancovitz, M., Paone, D., et al. (2001). Providing hepatitis B vaccination to injection drug users: Referral to health clinics vs on-site vaccination at a syringe exchange program. American Journal of Public Health, 91, 1791–1792.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Dore, G. J., & Thomas, D. L. (2005). Management and treatment of injection drug users with hepatitis C virus (HCV) infection and HCV/human immunodeficiency virus coinfection. Seminars in Liver Disease, 25, 18–32.

    Article  PubMed  Google Scholar 

  • Fisher, D. G., Reynolds, G. L., Jaffe, A., & Perez, M. J. (2006). Hepatitis and human immunodeficiency virus co-infection among injection drug users in Los Angeles County, California. Journal of Addictive Diseases, 25, 25–32.

    Article  PubMed  Google Scholar 

  • Gelberg, L., Robertson, M. J., Arangua, L., Leake, B. D., Sumner, G., Moe, et al. (2012). Prevalence, distribution, and correlates of hepatitis C virus infection among homeless adults in Los Angeles. Public Health Reports, 127, 407–421.

    PubMed Central  PubMed  Google Scholar 

  • Grebely, J., deVlaming, S., Duncan, F., Viljoen, M., & Conway, B. (2008). Current approaches to HCV infection in current and former injection drug users. Journal of Addictive Diseases, 27, 25–35.

    Article  PubMed  Google Scholar 

  • Hagan, H., Campbell, J., Thiede, H., Strathdee, S., Ouellet, L., Kapadia, F., et al. (2006). Self-reported hepatitis C virus antibody status and risk behavior in young injectors. Public Health Reports, 121, 710–719.

    PubMed Central  PubMed  Google Scholar 

  • Hagan, H., Pouget, E. R., & Des Jarlais, D. C. (2011). A systematic review and meta-analysis of interventions to prevent hepatitis C virus infection in people who inject drugs. Journal of Infectious Diseases, 204, 74–83.

    Article  PubMed Central  PubMed  Google Scholar 

  • Havens, J. R., Lofwall, M. R., Frost, S. D., Oser, C. B., Leukefeld, C. G., & Crosby, R. A. (2013). Individual and network factors associated with prevalent hepatitis C infection among rural Appalachian injection drug users. American Journal of Public Health, 103, e44–e52.

    Article  PubMed Central  PubMed  Google Scholar 

  • Heckathorn, D. D. (1997). Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems, 44, 174–199.

    Article  Google Scholar 

  • Hezode, C., Zafrani, E. S., Roudot-Thoraval, F., Costentin, C., Hessami, A., Bouvier-Alias, M., et al. (2008). Daily cannabis use: A novel risk factor of steatosis severity in patients with chronic hepatitis C. Gastroenterology, 134, 432–439.

    Article  PubMed  Google Scholar 

  • Ishida, J. H., Peters, M. G., Jin, C., Louie, K., Tan, V., Bacchetti, P., et al. (2008). Influence of cannabis use on severity of hepatitis C disease. Clinical Gastroenterology and Hepatology, 6, 69–75.

    Article  PubMed Central  PubMed  Google Scholar 

  • Jutras-Aswad, D., Zang, G., & Bruneau, J. (2010). Cannabis use correlates of syringe sharing among injection drug users. The American Journal on Addictions, 19, 231–237.

    Article  PubMed  Google Scholar 

  • Kaiser Commission on Medicaid and the Uninsured (2013) Key Facts about the Uninsured Population Retrieved Feb 12, 2014, from http://kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/

  • Kanwal, F., Schnitzler, M. S., Bacon, B. R., Hoang, T., Buchanan, P. M., & Asch, S. M. (2010). Quality of care in patients with chronic hepatitis C virus infection: A cohort study. Annals of Internal Medicine, 153, 231–239.

    Article  PubMed  Google Scholar 

  • Klevens, R. M., Hu, D. J., Jiles, R., & Holmberg, S. D. (2012). Evolving epidemiology of hepatitis C virus in the United States. Clinical Infectious Disease, 55, S3–S9.

    Article  Google Scholar 

  • Kuo, I., Mudrick, D. W., Strathdee, S. A., Thomas, D. L., & Sherman, S. G. (2004a). Poor validity of self-reported hepatitis B virus infection and vaccination status among young drug users. Clinical Infectious Diseases, 38, 587–590.

    Article  PubMed  Google Scholar 

  • Kuo, I., Sherman, S. G., Thomas, D. L., & Strathdee, S. A. (2004b). Hepatitis B virus infection and vaccination among young injection and non-injection drug users: Missed opportunities to prevent infection. Drug and Alcohol Dependence, 73, 69–78.

    Article  PubMed  Google Scholar 

  • Ly, K. N., Xing, J., Klevens, R. M., Jiles, R. B., Ward, J. W., & Holmberg, S. D. (2012). The increasing burden of mortality from viral hepatitis in the United States between 1999 and 2007. Annals of Internal Medicine, 156, 271–278.

    Article  PubMed  Google Scholar 

  • Maheshwari, A., & Thuluvath, P. J. (2010). Management of acute hepatitis C. Clinics in Liver Disease, 14, 169–176.

    Article  PubMed  Google Scholar 

  • Masson, C. L., Delucchi, K. L., McKnight, C., Hettema, J., Khalili, M., Min, A., et al. (2013). A randomized trial of a hepatitis care coordination model in methadone maintenance treatment. American Journal of Public Health, 103, e81–e88.

    Article  PubMed Central  PubMed  Google Scholar 

  • Mehta, S. H., Astemborski, J., Kirk, G. D., Strathdee, S. A., Nelson, K. E., Vlahov, D., et al. (2011). Changes in blood-borne infection risk among injection drug users. Journal of Infectious Diseases, 203, 587–594.

    Article  PubMed Central  PubMed  Google Scholar 

  • Mehta, S. H., Kirk, G. D., Astemborski, J., Galai, N., & Celentano, D. D. (2010). Temporal trends in highly active antiretroviral therapy initiation among injection drug users in Baltimore, Maryland, 1996-2008. Clinical Infectious Diseases, 50, 1664–1671.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Miller, C. L., Wood, E., Spittal, P. M., Li, K., Frankish, J. C., Braitstein, P., et al. (2004). The future face of coinfection: Prevalence and incidence of HIV and hepatitis C virus coinfection among young injection drug users. Journal of Acquired Immune Deficiency Syndromes, 36, 743–749.

    Article  PubMed  Google Scholar 

  • Mohd Hanafiah, K., Groeger, J., Flaxman, A. D., & Wiersma, S. T. (2013). Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology, 57, 1333–1342.

    Article  PubMed  Google Scholar 

  • Moyer, L. B., Brouwer, K. C., Brodine, S. K., Ramos, R., Lozada, R., Cruz, M. F., et al. (2008). Barriers and missed opportunities to HIV testing among injection drug users in two Mexico–US border cities. Drug and Alcohol Review, 27, 39–45.

    Article  PubMed Central  PubMed  Google Scholar 

  • Quaglio, G. L., Lugoboni, F., Pajusco, B., Sarti, M., Talamini, G., Mezzelani, P., et al. (2003). Hepatitis C virus infection: Prevalence, predictor variables and prevention opportunities among drug users in Italy. Journal of Viral Hepatitis, 10, 394–400.

    Article  CAS  PubMed  Google Scholar 

  • Robbins, J. L., Wenger, L., Lorvick, J., Shiboski, C., & Kral, A. H. (2010). Health and oral health care needs and health care-seeking behavior among homeless injection drug users in San Francisco. Journal of Urban Health, 87, 920–930.

    Article  PubMed Central  PubMed  Google Scholar 

  • Smith, B. D., Morgan, R. L., Beckett, G. A., Falck-Ytter, Y., Holtzman, D., Teo, C. G., et al. (2012). Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945–1965. MMWR Recommendations and Reports, 61, 1–32.

    PubMed  Google Scholar 

  • Stepanova, M., Kanwal, F., El-Serag, H. B., & Younossi, Z. M. (2011). Insurance status and treatment candidacy of hepatitis C patients: Analysis of population-based data from the United States. Hepatology, 53, 737–745.

    Article  PubMed  Google Scholar 

  • Tempalski, B., Pouget, E. R., Cleland, C. M., Brady, J. E., Cooper, H. L., Hall, H. I., et al. (2013). Trends in the population prevalence of people who inject drugs in US metropolitan areas 1992-2007. PLoS One, 8, e64789.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Tsui, J. I., Saitz, R., Cheng, D. M., Nunes, D., Libman, H., Alperen, J. K., et al. (2007). Awareness of hepatitis C diagnosis is associated with less alcohol use among persons co-infected with HIV. Journal of General Internal Medicine, 22, 822–825.

    Article  PubMed Central  PubMed  Google Scholar 

  • United States Census Bureau (2014) Health Insurance Coverage Status, 2009-201 American Community Survey 3-Year Estimates. Retrieved March 3, 2014, from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_11_3YR_S2701&prodType=table

  • Valdiserri, R., Khalsa, J., Dan, C., Holmberg, S., Zibbell, J., Holtzman, D., et al. (2014). Confronting the emerging epidemic of HCV infection among young injection drug users. American Journal of Public Health, 104, 816–821.

    Article  PubMed  Google Scholar 

  • Vickerman, P., Martin, N. K., Roy, A., Beattie, T., Jarlais, D. D., Strathdee, S., et al. (2013). Is the HCV-HIV co-infection prevalence amongst injecting drug users a marker for the level of sexual and injection related HIV transmission? Drug and Alcohol Dependence, 132, 172–181.

    Article  PubMed  Google Scholar 

  • Weber, R., Sabin, C. A., Friis-Moller, N., Reiss, P., El-Sadr, W. M., Kirk, O., et al. (2006). Liver-related deaths in persons infected with the human immunodeficiency virus: The D:A:D study. Archives of Internal Medicine, 166, 1632–1641.

    Article  PubMed  Google Scholar 

  • Wong, V., Wreghitt, T. G., & Alexander, G. J. (1996). Prospective study of hepatitis B vaccination in patients with chronic hepatitis C. British Medical Journal, 312, 1336–1337.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • Younossi, Z. M., Zheng, L., Stepanova, M., Venkatesan, C., & Mir, H. M. (2013). Moderate, excessive or heavy alcohol consumption: Each is significantly associated with increased mortality in patients with chronic hepatitis C. Alimentary Pharmacology & Therapeutics, 37, 703–709.

    Article  CAS  Google Scholar 

Download references

Acknowledgments

Funding for this work came from cooperative agreements with the Centers for Disease Control and Prevention (5U62PS000954 and 5U62PS000969). Data collection was based on CDC study protocols and monitored by CDC’s Division of HIV/AIDS Prevention. CDC had no role in the analysis and interpretation of the data or in the writing of the manuscript. The authors gratefully acknowledge the efforts of Toby LeRoux, Charles Chen, Theresa Mickiewicz in Denver and Nadine Snyder, Elizabeth Harrison, Kevin Kogin, Joshua O’Neal, Lindsey Jenkins in Seattle, for their tireless efforts in collecting and managing this important data. We also thank the numerous NHBS participants for giving of their time and providing us with this critical information.

Author information

Authors and Affiliations

  1. Denver Public Health, Denver Health and Hospital Authority, 605 Bannock Street, Denver, CO, 80204-4507, USA

    Alia A. Al-Tayyib

  2. Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA

    Alia A. Al-Tayyib

  3. Public Health – Seattle & King County, Seattle, WA, USA

    Hanne Thiede & Richard D. Burt

  4. Departments of Anthropology and Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA

    Stephen Koester

Authors
  1. Alia A. Al-Tayyib
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hanne Thiede
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard D. Burt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephen Koester
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alia A. Al-Tayyib.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al-Tayyib, A.A., Thiede, H., Burt, R.D. et al. Unmet Health Care Needs and Hepatitis C Infection Among Persons Who Inject Drugs in Denver and Seattle, 2009. Prev Sci 16, 330–340 (2015). https://doi.org/10.1007/s11121-014-0500-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11121-014-0500-4

Keywords

Search

Navigation