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Abstract Details
How the rural risk environment underpins hepatitis C risk: Qualitative findings from rural southern Illinois, United States
Int J Drug Policy. 2023 Feb;112:103930. doi: 10.1016/j.drugpo.2022.103930. Epub 2023 Jan 13.
1Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States. Electronic address: smk556@nyu.edu.
2Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States.
3College of Population Health, Thomas Jefferson University, United States.
4Department of Health Science, University of Alabama, Tuscaloosa, AL, United States.
5Department of Epidemiology, New York University School of Global Public Health, New York, NY, United States; Center for Drug Use and HIV/HCV Research, New York, NY, United States; College of Population Health, Thomas Jefferson University, United States; Department of Health Science, University of Alabama, Tuscaloosa, AL, United States; Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, United States; Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States; Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, United States; Department of Medicine, University of Chicago, Chicago, IL, United States; The Community Action Place, Murphysboro, IL, United States.
6Center for Drug Use and HIV/HCV Research, New York, NY, United States; Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States.
7Center for Drug Use and HIV/HCV Research, New York, NY, United States; Department of Population Health, New York University Grossman School of Medicine, United States.
8Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois Chicago, Chicago, IL, United States.
9Department of Population Science and Policy, SIU School of Medicine, Springfield, IL, United States.
10Department of Medicine, University of Chicago, Chicago, IL, United States.
Abstract
Background: Hepatitis C virus (HCV) infection has increased among persons who inject drugs (PWID) in the United States with disproportionate burden in rural areas. We use the Risk Environment framework to explore potential economic, physical, social, and political determinants of hepatitis C in rural southern Illinois.
Methods: Nineteen in-depth semi-structured interviews were conducted with PWID from August 2019 through February 2020 (i.e., pre-COVID-19 pandemic) and four with key informants who professionally worked with PWID. Interviews were recorded, professionally transcribed, and coded using qualitative software. We followed a grounded theory approach for coding and analyses.
Results: We identify economic, physical, policy, and social factors that may influence HCV transmission risk and serve as barriers to HCV care. Economic instability and lack of economic opportunities, a lack of physically available HCV prevention and treatment services, structural stigma such as policies that criminalize drug use, and social stigma emerged in interviews as potential risks for transmission and barriers to care.
Conclusion: The rural risk environment framework acknowledges the importance of community and structural factors that influence HCV infection and other disease transmission and care. We find that larger structural factors produce vulnerabilities and reduce access to resources, which negatively impact hepatitis C disease outcomes.