标题：Seroprevalence of HIV, Hepatitis B Virus, and HCV Among Injection Drug Users in Connecticut: Understanding Infection and Coinfection Risks in a Nonurban Population
摘要：Objectives. We examined HIV, hepatitis B virus (HBV), and HCV seroprevalence in an interim analysis and the potential risk factors associated with these infections among injection drug users (IDUs) residing in nonurban communities of southwestern Connecticut. Methods. We recruited and interviewed active adult IDUs about their injection-associated risk and conducted serological tests for HIV, HBV, and HCV. Regression analyses were performed to identify risk factors for infection and coinfection. Results. Among 446 participants, 51.6% carried at least 1 infection, and 16.3% were coinfected. Infection risk was associated with longer duration of injection use, overdose, substance abuse treatment, depression, and involvement with the criminal justice system. Coinfection was associated with longer injection drug use, lower education, overdose, and criminal justice involvement. Multivariate models identified injection drug use duration, substance abuse treatment, and criminal justice involvement as the most significant predictors of infection; injection drug use duration and education were the most significant predictors of coinfection. Conclusions. Suburban IDUs are at significant risk for acquiring single and multiple viral infections. Effective harm reduction strategies are needed to reach users early. There might be roles for interventions in the treatment and justice systems in which IDUs interact. In recent years there has been increasing evidence that nonmedical drug use and injection drug abuse have spread from urban, economically disadvantaged communities to suburban and rural locales throughout the United States. 1–5 Despite reports that provide evidence of the spreading problem of opioid abuse and injection drug abuse to nonurban locations, there is very little research that assesses risk factors for injection-associated infections among injection drug users (IDUs) who reside in suburban communities. Injection drug use is responsible for a significant proportion of the HIV, hepatitis B and C (HBV and HCV) cases in the United States, but this information comes from studies of urban IDUs. A summary of field studies—primarily from urban settings—places estimates of seroprevalence among IDUs at 8% to 26% for HIV, 51% to 90% for HBV, and 60% to 90% for HCV. 6 Prevalence among samples of IDUs was higher for African American and Hispanic IDUs and increased with age. Coinfection, especially with HIV and HCV was relatively common, and bears additional risks and complicates prognosis and medical treatment. 7–9 Therefore, for purposes of planning health care services and prevention initiatives for this population, we must address both the risk of infection and the risk of coinfection. However, little, if any of this information, comes from studies conducted in populations of nonurban injectors. To ameliorate this lack of information, we conducted a study to characterize the nature and extent of health risks associated with injection drug use in the suburbs of southwestern Connecticut. We defined “suburbs” for our study as being any town with populations of fewer than 100 000 individuals, which included all but 5 cities within the 2 counties of Fairfield and New Haven. Populations for these suburban towns ranged from 6000 to 51 000 in New Haven County and 4000 to 60 000 in Fairfield County. Although the cities and several pockets of small towns have long been considered to be heroin and opioid distribution “hubs,” 10,11 more recent evidence has documented the emergence of a relatively new demographic of suburban opioid users. 12 In the present report, we addressed 3 questions. (1) What is the seroprevalence of HBV, HCV, or HIV? (2) What risk factors are associated with infection with any 1 virus? (3) What risk factors are associated with coinfection? We aimed to illuminate the overall picture of injection drug use–associated infection in this previously overlooked population and to identify specific risk factors that might serve as foci for interventions in the future. Possible risk factors, based in part on studies in the urban centers of Connecticut, included sociodemographic characteristics, 13–15 risk behaviors, 15,16 medical factors (including mental health and use of health services), 17 and interactions with the substance abuse treatment and criminal justice systems. 18–20
