Drug use and other behaviors, and poor support systems, make Appalachia ripe for liver-damaging hepatitis C virus

The hepatitis C virus is a growing problem in Appalachia because of "high rates of injection use, little access to intervention services and tight-knit social circles," according to research conducted by the University of Kentucky since 2008 in Perry County, Elizabeth Adams reports for UKNow.

Hepatitis C is a contagious liver disease caused by a virus, according to the federal Centers for Disease Control and Prevention. It can be either acute or chronic, and is spread primarily through contact with the blood of an infected person, which most often occurs when people share needles or other equipment to inject drugs. Most cases progress to a chronic disease, ultimately leading to liver complications and failure.

Dr. Jennifer Havens

The research, led by Jennifer Havens, an epidemiologist in UK's Center for Drug and Alcohol Research, has tracked cases of this highly infectious virus through routine testing and interviews with 500 drug users in Perry County. Most new cases have been found in people under the age of 25.

Havens hopes to learn about the "social and behavioral risk factors that contribute to the area's prevalence of hepatitis C" and use this information to develop interventions to decrease the spread of the disease, Adams writes.

"When you think about rural communities, you think of a tight knit group -- everyone knows everyone else," Havens told Adams. "And that's what is going on here. We are seeing great potential for disease transmission."
Participants in the study were interviewed about their drug use, sexual activity and social networks. They were also tested for hepatitis C, herpes simplex II and HIV, which has not yet been identified in the tested population, Adams reports. With a participation retention rate of 95 percent over five years, researchers were able to "map support networks, drug use networks and sexual networks, as well as identify systemic changes in the drug use of the community."

When the study began in 2008, nearly 43 percent of the participants had hepatitis C, with 80 percent reporting a history of injection drug use, Adams reports.There have been 94 new cases in the past five years, and 62 percent of the participants now have the virus.

Havens said Appalachian communities have the disadvantage of being isolated from drug intervention resources, such as mobile syringe exchanges, which provide users with sanitary tools such as bleach kits, to prevent transmission or "more importantly a known community location for accessing drug treatment."

The newest medication to treat or manage hepatitis C costs $90,000 for total treatment, or $1,000 per dose, which is hardly affordable or accessible to low-income and uninsured drug users, Adams writes. Only 10 percent of the Appalachian study's participants have private insurance, while two-thirds are uninsured.

Information from this research will help Havens and her researchers develop intervention programs. Participants have suggested a syringe exchange program. Havens would like to design an intervention program utilizing the existing social networks to reduce the risk of overdose through health resource information sharing, Adams notes. Havens also emphasizes the importance of "available, accessible and affordable drug treatment to curb injection drug use and the growing rates of hepatitis C."

The Centers for Disease Control and Prevention estimates 3 million Americans are infected with hepatitis C, but thousands more are unknowingly carrying the virus.

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