title: Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut.
abstract: Little is known about injection-associated risk behaviours, knowledge and seroprevalence of viral infections among people who inject drugs (PWID) in nonurban locales in the US. Harm reduction services are more available in urban locales. The present study examined a cohort of active PWID residing in non urban areas of Connecticut to investigate how primarily injecting in urban or non urban areas was associated with injection-associated risk behaviours, knowledge and prevalence of blood-borne viruses.
  
  
  
  We described the sample and performed bivariate and multivariable analyses on injection-associated risk behaviours, HIV/hepatitis/overdose knowledge and baseline serological data to identify differences between individuals who injected primarily in nonurban locales and those who did not.
  
  
  
  Harm reduction knowledge and use of harm reduction services were poor in both groups. Those injecting most often in urban settings were 1.88 (1.19, 2.98 95% confidence interval) times more likely to engage in at least one injection-associated risk behaviour than their nonurban counterpart. Seroprevalence rates (23.6% for hepatitis B virus, 39.2% for hepatitis C virus, and 1.1% for HIV) were no different between the two groups.
  
  
  
  The data provided little evidence that the benefits of urban harm reduction programs, such as syringe exchange, risk reduction interventions and education programs have penetrated into this nonurban population, even among those who injected in urban locales where such programs exist. Harm reduction interventions for nonurban communities of PWID are needed to reduce HIV and hepatitis B and C transmission. [Grau LB, Zhan W, Heimer R. Prevention knowledge, risk behaviours and seroprevalence among nonurban injectors of southwest Connecticut. Drug Alcohol Rev 2016;35:628-636].
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA. lauretta.grau@yale.edu.
authors.forename: Lauretta E
authors.initials: LE
authors.lastname: Grau
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.|Department of Children and Families, Hartford, USA.
authors.forename: Weihai
authors.initials: W
authors.lastname: Zhan
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
mesh_terms: D000328:Adult; D003237:Connecticut; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D040261:Harm Reduction; D006509:Hepatitis B / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs; D015995:Prevalence; D012309:Risk-Taking; D016036:Seroepidemiologic Studies; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D055815:Young Adult
keywords: HIV/AIDS; hepatitis; injection drug use; prevalence; risk