Seroprevalence of HCV and HIV infection among clients of the nation's longest-standing statewide syringe exchange program: A cross-sectional study of Community Health Outreach Work to Prevent AIDS (CHOW) Project participants, Hawai‘i, 2012

Thomas P. Salek, Alan R. Katz, Stacy M. Lenze, Heather M. Lusk, Dongmei Li, Don Des Jarlais

Research output: Contribution to journalArticle

Abstract

Background The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O‘ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. Methods A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age–HCV relationship. Results The estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI] = 59.5–75.8%). HIV seroprevalence was 2.3% (95% CI = 0–4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR] = 1.03; 95% CI = 1.02–1.05) and months exchanging syringes (quartiles) (APPR = 1.92; 95% CI = 1.3–3.29) were independently associated with anti-HCV prevalence. Conclusion In Hawai‘i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.

Original languageEnglish (US)
Pages (from-to)34-43
Number of pages10
JournalInternational Journal of Drug Policy
Volume48
DOIs
StatePublished - Oct 1 2017

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Needle-Exchange Programs
Community-Institutional Relations
Seroepidemiologic Studies
Virus Diseases
Hepacivirus
Acquired Immunodeficiency Syndrome
Cross-Sectional Studies
HIV
Health
Confidence Intervals
Point-of-Care Systems
Blood-Borne Pathogens
Hepatitis C Antibodies
Syringes
Statistical Models
Risk-Taking
Pharmaceutical Preparations

Keywords

  • Cross-sectional studies
  • Hepatitis C
  • HIV
  • Needle-exchange programs

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

@article{931bd6f12ec34bd89f57b48ec7e94045,
title = "Seroprevalence of HCV and HIV infection among clients of the nation's longest-standing statewide syringe exchange program: A cross-sectional study of Community Health Outreach Work to Prevent AIDS (CHOW) Project participants, Hawai‘i, 2012",
abstract = "Background The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O‘ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. Methods A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age–HCV relationship. Results The estimated seroprevalence of HCV was 67.7{\%} (95{\%} confidence interval [CI] = 59.5–75.8{\%}). HIV seroprevalence was 2.3{\%} (95{\%} CI = 0–4.9{\%}). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6{\%} through 90.9{\%} in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR] = 1.03; 95{\%} CI = 1.02–1.05) and months exchanging syringes (quartiles) (APPR = 1.92; 95{\%} CI = 1.3–3.29) were independently associated with anti-HCV prevalence. Conclusion In Hawai‘i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.",
keywords = "Cross-sectional studies, Hepatitis C, HIV, Needle-exchange programs",
author = "Salek, {Thomas P.} and Katz, {Alan R.} and Lenze, {Stacy M.} and Lusk, {Heather M.} and Dongmei Li and {Des Jarlais}, Don",
year = "2017",
month = "10",
day = "1",
doi = "10.1016/j.drugpo.2017.06.009",
language = "English (US)",
volume = "48",
pages = "34--43",
journal = "International Journal of Drug Policy",
issn = "0955-3959",
publisher = "Elsevier",

}

TY - JOUR

T1 - Seroprevalence of HCV and HIV infection among clients of the nation's longest-standing statewide syringe exchange program

T2 - A cross-sectional study of Community Health Outreach Work to Prevent AIDS (CHOW) Project participants, Hawai‘i, 2012

AU - Salek, Thomas P.

AU - Katz, Alan R.

AU - Lenze, Stacy M.

AU - Lusk, Heather M.

AU - Li, Dongmei

AU - Des Jarlais, Don

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O‘ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. Methods A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age–HCV relationship. Results The estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI] = 59.5–75.8%). HIV seroprevalence was 2.3% (95% CI = 0–4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR] = 1.03; 95% CI = 1.02–1.05) and months exchanging syringes (quartiles) (APPR = 1.92; 95% CI = 1.3–3.29) were independently associated with anti-HCV prevalence. Conclusion In Hawai‘i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.

AB - Background The Community Health Outreach Work to Prevent AIDS (CHOW) Project is the first and longest-standing statewide integrated and funded needle and syringe exchange program (SEP) in the US. Initiated on O‘ahu in 1990, CHOW expanded statewide in 1993. The purpose of this study is to estimate the prevalences of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, and to characterize risk behaviors associated with infection among clients of a long-standing SEP through the analysis of the 2012 CHOW evaluation data. Methods A cross-sectional sample of 130 CHOW Project clients was selected from January 1, 2012 through December 31, 2012. Questionnaires captured self-reported exposure information. HIV and HCV antibodies were detected via rapid, point-of-care FDA-approved tests. Log-binomial regressions were used to estimate prevalence proportion ratios (PPRs). A piecewise linear log-binomial regression model containing 1 spline knot was used to fit the age–HCV relationship. Results The estimated seroprevalence of HCV was 67.7% (95% confidence interval [CI] = 59.5–75.8%). HIV seroprevalence was 2.3% (95% CI = 0–4.9%). Anti-HCV prevalence demonstrated age-specific patterns, ranging from 31.6% through 90.9% in people who inject drugs (PWID) <30 to ≥60 years respectively. Age (continuous/year) prior to spline knot at 51.5 years (adjusted PPR [APPR] = 1.03; 95% CI = 1.02–1.05) and months exchanging syringes (quartiles) (APPR = 1.92; 95% CI = 1.3–3.29) were independently associated with anti-HCV prevalence. Conclusion In Hawai‘i, HCV prevalence among PWID is hyperendemic demonstrating age- and SEP duration-specific trends. Relatively low HIV prevalence compared with HCV prevalence reflects differences in transmissibility of these 2 blood-borne pathogens and suggests much greater efficacy of SEP for HIV prevention.

KW - Cross-sectional studies

KW - Hepatitis C

KW - HIV

KW - Needle-exchange programs

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U2 - 10.1016/j.drugpo.2017.06.009

DO - 10.1016/j.drugpo.2017.06.009

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JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

SN - 0955-3959

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