title: Viral hepatitis and injection drug use in Appalachian Kentucky: a survey of rural health department clients.
abstract: OBJECTIVE
  We identified correlates of exposure to hepatitis B and C viruses among health department clients in Appalachian Kentucky, a rural region noted for high poverty and low education. Additionally, we investigated risk factors for transmission, and the frequency of use of preventive measures.
  
  
  METHODS
  Patients screened for hepatitis B or C at four county health departments in Appalachian Kentucky were administered a routine prescreening questionnaire and an additional survey designed to obtain detailed personal and behavioral risk factor data. These data were linked to produce a more comprehensive dataset for analysis, including test results, which were attached to the prescreening questionnaire.
  
  
  RESULTS
  In total, 92 health department clients participated in the study survey. Of these, test results were available for 80 of the clients. Very few subjects who enrolled in this study tested positive for hepatitis B. Twelve out of 80 participants (15%) tested positive for previous exposure to hepatitis C. No participants reported having human immunodeficiency virus.
  
  
  CONCLUSIONS
  Transmission of hepatitis C in these rural Appalachian communities is predominantly due to injection drug use. Patients with hepatitis C exposure are similar in their demographic and risk profiles as those seen in urban areas and, despite small numbers, can have a serious impact on small, rural public health systems.
authors.affiliation: College of Medicine, University of Kentucky, Lexington, KY 40504, USA.
authors.forename: W Jay
authors.initials: WJ
authors.lastname: Christian
authors.forename: Claudia
authors.initials: C
authors.lastname: Hopenhayn
authors.forename: Amy
authors.initials: A
authors.lastname: Christian
authors.forename: Deana
authors.initials: D
authors.lastname: McIntosh
authors.forename: Alvaro
authors.initials: A
authors.lastname: Koch
mesh_terms: D000328:Adult; D001061:Appalachian Region / Q000453:epidemiology; D005260:Female; D006509:Hepatitis B / Q000097:blood / Q000453:epidemiology* / Q000635:transmission; D006526:Hepatitis C / Q000097:blood / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019035:Rural Health Services; D016036:Seroepidemiologic Studies; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000821:virology
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