New HCV Infection Trend Among Young People Who Inject DrugsInjection drug use is known to play a major role in HCV transmission. Surveillance data shared by Massachusetts in 2010 put a spotlight on an emerging HCV infection trend among young PWID. That year, the Massachusetts Department of Public Health analyzed chronic hepatitis C infection data and observed an increase of HCV among persons aged 15–24 between 2002 and 2009. The young people being reported were from all over the state, almost all outside of metropolitan Boston, primarily White, and equally male and female. In-depth interviews with a number of these HCV-positive young people uncovered that most were IDUs who had started opioid use by first misusing oral oxycodone around 1–1.5 years before transitioning to injecting heroin.
After the Massachusetts findings were published, other jurisdictions across the country, began to report similar findings: rising rates of hepatitis C infection among young injectors, both male and female, primarily White, found in suburban and rural settings, who started misusing prescription opioids (e.g., oxycodone) before transitioning to heroin injection.
Participants in the consultation shared that HCV transmission among young IDUs is highly efficient, with young injectors frequently acquiring HCV soon after they first begin to inject opioids. This indicates that the window for HCV prevention interventions targeting this population is narrow. In addition to drug use behaviors, other risk factors influence their risk of acquiring or transmitting HCV including homelessness and a lack of understanding about their risk of infection with HCV and how to prevent it.
The size of this population is significant. An analysis of data from the National Household Survey on Drug Abuse between 1979-2002 (now the National Survey on Drug Use and Health) estimated that 590,000 young adults aged 18–29 had ever injected drugs. As the surveys do not include institutionalized or homeless individuals, it is likely that these figures are underestimates. Among these young injectors, it is estimated that as many as 45% (265,000) are infected with HCV.
There is growing concern that these increases could begin to reverse the declines in overall HCV incidence and prevalence observed by the CDC over the past decade. It is clear that federal, state local and community partners need to take action if we are to mount a sound public health response.
Strategies to Address HCV Infection Among Young PWIDDuring the consultation, researchers, federal agency representatives, providers, and community leaders shared presentations on key facts about the epidemiology of HCV infection among this population, the state of current research, and examples of innovative community responses. The consultants engaged in robust, highly interactive discussions identifying successes, challenges, and gaps and proposing strategies to address the issues that emerged. A summary of the presentations and the groups’ recommendations are presented in a meeting summary report .
The consultation participants recommended several key public health actions including:
- Create community-led education and messaging strategies on hepatitis C risks, injection transmission risks (e.g., sharing drug preparation equipment in addition to sharing drug injection equipment), and HCV testing resources.
- Improve and increase infrastructure for HCV surveillance and data collection.
- Create age-appropriate (e.g., young adult) substance use and hepatitis C interventions and prevention strategies that are evidence based and effective.
- Expand both community-based and basic science research activities to better understand how to effectively address the emerging crisis of hepatitis C infection among young IDUs.