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Increased Social Support Linked to HCV Status Awareness, Treatment Uptake

Individuals with a history of injection drug use who have a robust social support system are more likely to seek care for hepatitis C virus (HCV) infection, according to study results published in Open Forum Infectious Diseases.

Researchers conducted a secondary analysis of data captured from a cluster-randomized trial (ClinicalTrials.gov identifier: NCT03567174) comprising patients who use injectable drugs. They aimed to explore social determinants of health that impact the HCV care cascade, including linkage to medications for opioid use disorder programs, employment/income, social support, health care access, health-related stigma, education level, housing, and contact with the carceral system. Study patients included adults who self-reported either injection drug use on at least 4 days within the past month or needle/syringe sharing within the past 6 months. At baseline, patients completed a survey and provided blood and urine samples for biomarker testing. The primary outcomes included awareness of HCV infection and HCV treatment. Chi-squared and t-testing were used to compare categorical and continuous variables. Multivariate logistic regression was used to assess factors associated with awareness of positive HCV status, with adjustments for significant covariates and age, race, and gender.

A total of 342 patients were included in the final analysis, of whom the median age was 52 years, 64.7% were men, 67.7% were Black or African American, 92.2% identified as heterosexual, 67.6% were HCV seropositive, and 52.7% reported daily injection drug use.

Overall, men were less likely than women to be aware of their HCV status (adjusted odds ratio [aOR], 0.41; 95% CI, 0.22-0.74). Other factors significantly associated with HCV status awareness were as follows:

  • HIV positivity (aOR, 2.73; 95% CI, 1.19-7.15);
  • Having a primary care provider (PCP; aOR, 1.97; 95% CI, 1.10-3.58);
  • Report of others sharing their positive HCV status (aOR, 2.27; 95% CI, 1.31-3.99);
  • Time at current residence (≥6 months; aOR, 0.35; 95% CI, 0.17-0.67); and
  • Employment (aOR, 0.34; 95% CI, 0.15-0.76).

There was no significant relationship observed between HCV status awareness and age, race, or enrollment in an opioid use disorder program. Marital status and number of close friends or relatives also were not indicated as significant factors.

Of 251 patients with chronic HCV infection who were aware of their HCV status, 86 (34.3%) reported prior receipt of treatment. Among those who received prior treatment, 54 (62.8%) had undetectable HCV RNA levels.

Men were more likely than women to report prior treatment for HCV infection (aOR, 2.64; 95% CI, 1.37-5.24). Other factors associated with prior receipt of HCV treatment were as follows:

  • White race/ethnicity (aOR, 0.37; 95% CI, 0.13-0.97);
  • HIV positivity (aOR, 2.33; 95% CI, 1.15-4.84);
  • Having a PCP (aOR, 2.32; 95% CI, 0.99-5.91);
  • Health insurance coverage (aOR, 1.61; 95% CI, 0.32-12.02); and
  • Lack of housing (aOR, 0.49; 95% CI, 0.07-2.26).

In a subgroup analysis of patients who were aware of their chronic HCV status, women were significantly less likely to have a PCP compared with men (63.4% vs 80%, respectively; P =.01). Compared with Black or African American patients, White patients were more likely to report lack of housing and daily injection drug use or transactional sex, but less likely to have health insurance coverage or a PCP and a high number of social connections.

Study limitations include the reliance on self-reported data, potentially low generalizability, and the possibility of recall bias, social desirability bias, and temporal bias.

“Models of care that provide comprehensive services such as housing support, medical care including primary care and infectious disease services, as well as integrated harm reduction services should be expanded,” the researchers concluded.

By Janelle Barowski

References:

Corro LAG, Zook K, Landry M, et al. An analysis of social determinants of health and their implications for hepatitis C virus treatment in people who inject drugs: the case of Baltimore. Open Forum Infect Dis. Published online March 2, 2024. doi:10.1093/ofid/ofae107

Source: Infectious Disease Advisor