ArticleThe International journal on drug policy2025
Associations of hepatitis C virus (HCV) antibody positivity with opioid, stimulant, and polysubstance injection among people who inject drugs (PWID) in rural U.S. communities.
Article in The International journal on drug policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 9 citations in OpenAlex.
- Harm Reduction in Peer-Assisted Telemedicine for Hepatitis C: Secondary Outcomes of a Randomized Controlled Trial.Viruses · 2024Trial
- Trends in HCV Prevalence and Risk Factors Among People who Inject Drugs in Los Angeles County, 2012-2024.AIDS and behavior · 2026Article
- Integrated Studies of Infectious Disease Elimination (InSIDE): Hepatitis C Antibody and RNA Status of Persons Who Inject Drugs in New York State, 2021-2023.Journal of viral hepatitis · 2026Article
- Drug Use and Social Connectivity Related to Hepatitis C Infection Among Rural People Who Use Drugs.Journal of viral hepatitis · 2026Article
- Awareness of hepatitis C knowledge among four high-risk populations in Xiamen, China: a cross-sectional study.BMC infectious diseases · 2026Article
- The risk of HIV and HCV transmission in Canadians living with coinfection before, during, and after the COVID pandemic: A prospective cohort study.Canadian journal of public health = Revue canadienne de sante publique · 2026Article
- Genomic surveillance uncovers regional variation in HCV transmission networks in rural United States.Nature communications · 2025Article
- Introduction to the special section on polysubstance use: Emerging trends, psychosocial drivers, and treatment challenges.The International journal on drug policy · 2025Article
- Ecological momentary assessment study of same-hour polysubstance use among people who use opioids and additional substances.Drug and alcohol dependence · 2025Article
- Serious Bacterial Infections and Hepatitis C Virus Among People Who Inject Drugs: A Syndemic or Intertwined Epidemics?Tropical medicine and infectious disease · 2025Article
- Unmet needs and harm reduction preferences of syringe services program participants: differences by co-use of illicit opioids and methamphetamine.Harm reduction journal · 2024Article
Corrections and comments
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Authors and funding
17 authors at 12 institutions in 1 country.
Funding
Abstract
backgroundPeople who inject drugs (PWID) in the rural U.S. often inject stimulants, alone or with opioids. The impact of these substance use patterns may influence HCV risk behaviors. This analysis examines the associations of HCV antibody positivity with injecting only opioids, only stimulants (methamphetamine/cocaine), and opioids and stimulants together among rural PWID.
methodsThe Rural Opioid Initiative (ROI) consists of eight research sites that enrolled people who use drugs in rural communities in ten U.S. states from 2018 to 2020. This cross-sectional analysis included adult participants who resided in a study area and injected any drug in the past 30 days. The primary outcome was HCV antibody positivity. The exposure of interest was injection drug use classified as only opioids, only stimulants, separate injections of opioids and stimulants, and same-syringe injection of both in the past 30 days. We used multivariable log-binomial regression with generalized linear mixed models to generate prevalence ratios (P.R.) adjusted for demographics, injection history, health insurance, and substance use treatment.
resultsAmong 3,084 participants enrolled in the ROI, 1,982 met inclusion criteria. Most participants injected opioids and stimulants in the same syringe (34%) or separately (21%), followed by injecting only stimulants (26%), and injecting only opioids (19%). Half (51%) were HCV antibody positive. Compared to people who injected only stimulants, HCV antibody positivity was more prevalent among people who injected opioids alone (aPR=1.62, 95% CI:(1.29-2.03)), injected both opioids and stimulants separately (aPR=1.61, 95% CI:(1.32-1.95)), and in the same syringe (aPR=1.54, 95% CI:(1.28-1.85)).
conclusionHCV antibody positivity, indicating prior exposure, was highest among those who had recently injected opioids, alone or with stimulants. Additional nucleic acid testing is necessary to confirm active infection. More research is needed to determine the underlying causes of HCV antibody positivity by injection use.
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