CINCINNATI—A University of Cincinnati (UC) professor has received a three-year, $900,000 grant from the U.S. Centers for Disease Control and Prevention (CDC) to study and combat the spread of hepatitis C among young adults in rural and suburban areas in southern Ohio who inject drugs.
"The purpose of the grant is to do both epidemiologic and interventionist work with young people, ages 18 to 30, who inject drugs and either already have hepatitis C or are at risk of contracting hepatitis C,” says Judith Feinberg, MD, professor of internal medicine at UC.
Feinberg, principal investigator on the grant, is working with co-investigator Erin Winstanley, PhD, assistant professor of health outcomes in the James L. Winkle College of Pharmacy
"This is an important public health project as rates of hepatitis C are higher in suburban and rural areas than in urban areas,” says Winstanley. "This grant will allow us to collect important epidemiological data and improve engagement in interventions that can prevent and reduce transmission of hepatitis C."
The grant will allow the researchers to hire and train outreach workers to recruit young people who use injection drugs and have hepatitis C or are at risk of contracting it and are residing in one of 21 counties across southern Ohio. Those counties are: Adams, Athens, Brown, Butler, Clermont, Clinton, Fayette, Gallia, Greene, Highland, Hocking, Jackson, Lawrence, Meigs, Montgomery, Pike, Preble, Ross, Scioto, Vinton and Warren.
The project is known as Southern Ohio Prevents Hepatitis Project or StOPHeP.
"The idea is to focus on suburban and rural areas, where the heroin and opioid drug epidemic is really centered,” says Feinberg, noting that Hamilton County is not part of the grant because it’s considered an urban center. Participants will be tested for hepatitis and HIV, and those who are infected will be referred to area physicians for medical care.
Outreach workers will recruit young injection drug users by working with drug treatment programs in Dayton and Athens and syringe exchange and substance abuse education programs that operate in Portsmouth and Cincinnati. Outreach workers will also make use of social networking and texting to connect with those at risk, says Feinberg.
"Because this is aimed at young people there is a lot of social media involvement, and the outreach staff we are going to have in the field will also be young people with a lived history of injection drug use that have been clean for at least two years,” explains Feinberg.
"Some of these people live in very isolated rural areas and continued face-to-face sessions with these individuals would be difficult, so we have a closed social network that will be a key part of this project,” she says.
"You can only access this social network site if you are invited in and there will be two chat rooms, a room for the people who already have hepatitis C that will focus on education to prevent spread of hepatitis C and support for getting treated, and a room for people who don’t yet have hepatitis C where the focus is trying to keep them from contracting the disease,” says Feinberg.
Hepatitis C is treatable and can be cured, but it is very expensive. The U.S. Food and Drug Administration (FDA) has approved a number of new drugs, including sofosbuvir, which costs $84,000 for a 12-week course. But Feinberg says that beats the cost of a having to replace a liver if the disease goes unchecked.
"It’s very clear that this epidemic involves young people and the challenge is to reach them. That’s why this project is so heavy on communication by social media,” says Feinberg. "Tragically, young people are not only using these drugs but are developing hepatitis C as teens and young adults. That’s not good because the natural history of hepatitis C is 80 percent of the people who get it will develop chronic liver disease.
"They will go on to have various liver problems, like cirrhosis and liver cancer, so it is really important to intervene early for those who already have chronic hepatitis C, and to prevent other young people who inject drugs from getting it. We are going to be really working on methods to figure that out,” she says.
"We want to find out, ‘Who exactly are these young people and what made them vulnerable to injection drug use?’” Feinberg says. "’Why is it mostly young men and not young women?’ There are a lot of questions to answer. We do know in general that the regional injection drug and hepatitis C epidemics are mostly male, mostly white and mostly rural and suburban. It is also appears to be mostly people who have jobs. Now we have to flesh out a lot of the data and fill in the blanks so we can find out how best to deal with the problem.”