Multiple Tactics Needed to Combat Hepatitis C in Young Drug Users

With hepatitis C infections on the rise among young injection drug users, researchers have recommended a range of promising prevention tactics.

The number of young adults infected with the hepatitis C virus (HCV) is on the rise, and researchers estimate that more than 31,000 young injection drug users could become infected each year in the United States. To help reduce the rate of HCV infection in young drug users, the authors of a new review suggest 6 strategies to prevent the spread of the virus.

The recommendations, published in an August 15, 2013, supplement to Clinical Infectious Diseases, are based primarily on evidence from the large, ongoing “U Find Out” (UFO) study. The study, which began in 2000, enrolls HCV-negative injection drug users younger than 30 in San Francisco, California, and keeps track of the rate of new infections. This data, coupled with results of additional studies, has helped researchers identify a range of promising HCV prevention tactics.

The first suggestion focuses on the reduction of shared drug equipment. A meta-analysis of 21 studies found that the risk of contracting HCV from shared use of drug preparation containers, filters, and rinse water was similar to the risk of infection associated with sharing syringes. If drug preparation equipment sharing were eliminated, the results indicated, a large portion of HCV infections could be prevented. The authors of the current review note that education, training, and increasing the availability of single-use supplies are necessary to prevent new HCV infections.

Although little research has been done to evaluate the efficacy of safety education in injectors, the review authors next suggest that testing and counseling populations at risk for HCV may reduce risky behavior as well as the spread of the virus. In the UFO study, researchers found that drug injectors reduced their alcohol intake and used less non-injection drugs within 6 months of receiving HCV-positive test results, indicating that testing may reduce risky behaviors. The authors are optimistic that the availability of rapid HCV point-of-care tests, recently approved by the FDA, may increase rates of HCV testing, diagnosing, and treatment.

The third tactic recommended by the authors is to develop intervention strategies at a relationship level, as drug use is often a social activity. The UFO study indicates that injectors in sexual relationships with other injectors are more likely to share needles with their partners and, therefore, are at heightened risk of HCV infection. Given the results of a recent study that showed that couple-based testing and counseling effectively reduced risky behaviors in injectors, the authors note that researchers should assess the impact of these interventions on HCV outcomes.

The reviewers next recommend an increase in injection cessation interventions. Evidence from the UFO study suggests that even temporary injection cessation helps prevent HCV infections. The authors note that encouraging injectors to quit, even after multiple failed attempts, may prevent the spread of HCV infections and increase the number of users who quit permanently.

The fifth strategy, based on mathematical models, is to increase needle distribution, expand HCV treatment, and continue to research and develop vaccines against HCV. Researchers modeled the effects of syringe availability on HIV and HCV prevalence among drug injectors in Australia and estimated that increasing the number of needles distributed each year in the United States from 30 million to 60 million could potentially cut the number of new HCV infections in half.

Finally, the authors suggest the adoption of programs combining multiple prevention strategies. The results of a study conducted in the United Kingdom suggested that high coverage of opioid substitution treatment combined with syringe distribution programs could reduce the risk of new HCV infections by up to 80%. Combined prevention methods were also shown to be significantly more effective in reducing HCV rates than a single method in 2 separate studies.

Although the authors have identified strategies they believe will help reduce the spread of HCV, they note that political backing and additional resources will be needed to implement these tactics and to overcome the many obstacles to reducing the infection rate in young injectors.