The overall goal of this project is to develop an integrated comprehensive approach for detection, prevention, linkage to care and treatment for hepatitis C (HCV) among young adults (18-30 years old) who have a history of injection drug use (people who inject drugs, PWID) and live in 21 non-urban southern Ohio counties. We will accomplish this by collaborating with addiction treatment providers, public health agencies, and syringe exchange programs in the target areas to identify, test, refer and link PWID to prevention and treatment services. The target area includes 21 suburban (large fringe metro, small metro) and rural (micropolitian, non-core) counties in southern Ohio, 18 of which are classified as Appalachian. To develop and implement a comprehensive strategy to address the high prevalence of HCV in southern Ohio, we will 1) identify and describe the demographic characteristics and risk behaviors and injection networks of young non-urban PWID, and test them for HCV, hepatitis B (HBV) and HIV;2) use Peer Navigators to link young non-urban PWID to addiction treatment programs and to primary care, mental health and specialty treatment (infectious diseases, hepatology), including linkage to health insurance through the Affordable Care Act and expanded Ohio Medicaid;3) use Peer Navigators to provide education on safe injection practices to prevent hepatitis and HIV;and link PWID to syringe exchange programs as available in target communities;4) use a closed social networking site (SNS) to provide peer-facilitated support for the uninfected prevention group (Prevention Room) and for the linkage-to-care group for PWID with HBV, HCV and/or HIV infection (Treatment Room);available both online and via smartphone;and 5) perform follow-up assessment and re-testing of study participants for HCV within 12 months of study entry to determine rates of new HCV infection and reinfection after successful treatment. Since the majority of the target counties are in Appalachia, this proposal will address healthcare inequities that are endemic to this region, and will provide data on which to base future public health initiatives to reduce HCV among young non-urban PWID.
Injection drug use (IDU) among young adults in rural areas and the resultant epidemic of chronic hepatitis C has become a significant public health problem, but there are few data about the demographics and risk behaviors of rural IDUs to inform public health policies and practice. The use of Peer Navigators and social media will enable us to provide peer support for isolated individuals and ensure study retention and linkage to care. Moreover, linkage to prevention, drug treatment and medical care including infectious disease care for chronic viral infections will provide data on the outcomes of these efforts in a rural setting.