The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994-2004.
OBJECTIVE
Our purpose was to assess whether participation in needle exchange programs (NEPs) influenced incident hepatitis C virus (HCV) infection through effects on injection risk behaviors among young injection drug users (IDUs) in the United States.


METHODS
Data were drawn from three multi-site studies carried out in four major cities that enrolled IDUs over the period 1994-2004. Bivariate and multivariate analyses were conducted to assess relationships among sociodemographic characteristics, NEP use, injection risk behaviors, and prevalent or incident HCV infection.


RESULTS
Of the total participants (n=4663), HCV seroprevalence was 37%; among those who initially tested negative and completed follow-up at three, six, or 12 months (n=1288), 12% seroconverted. Nearly half of participants reported NEP (46%) use at baseline. Multivariate results showed no significant relationship between NEP use and HCV seroconversion. Controlling for sociodemographic characteristics, IDUs reporting NEP use were significantly less likely to share needles (aOR=0.77, 95% CI=0.67-0.88). Additionally, controlling for sociodemographic characteristics and program use, sharing needles, sharing other injection paraphernalia, longer injection duration, and injecting daily were all positively related to prevalent infection.


CONCLUSIONS
Our results suggest an indirect protective effect of NEP use on HCV infection by reducing risk behavior.
Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mailstop G-37, Atlanta GA 30333, USA. dxh4@cdc.gov
Deborah
D
Holtzman
Vaughn
V
Barry
Lawrence J
LJ
Ouellet
Don C
DC
Des Jarlais
David
D
Vlahov
Elizabeth T
ET
Golub
Sharon M
SM
Hudson
Richard S
RS
Garfein
D000293:Adolescent; D000328:Adult; D055030:Drug Users; D005260:Female; D040261:Harm Reduction; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs; D012309:Risk-Taking; D016036:Seroepidemiologic Studies; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000821:virology*; D014481:United States / Q000453:epidemiology; D014504:Urban Health; D055815:Young Adult