The vast majority
(80%) of young people with hepatitis C virus (HCV) infection in the United
States have to travel at least ten miles to access needle exchange programmes,
investigators report in the online edition of Clinical Infectious Diseases. Patients lived an average of 37 miles
from their nearest syringe service programme (SSP), with distances especially long
in Southern and Midwestern states. Even in urban areas, only 53% of young people with
HCV were within ten miles of an SSP.
demonstrate that over 23,000 young people identified with current HCV infection
in the US over a one-year period had limited access to SSP services,” comment
the authors. “Given that injection drug use is the primary cause of HCV
infection among young people, better access to SSPs could have been a useful
tool to prevent many of these HCV infections and reduced the risk of
transmission to others.”
Incidence of HCV
in the US doubled between 2010 and 2014. The largest increase was among
people aged 20 to 29 years living in non-urban areas. Most of these infections
can be attributed to the use of non-sterile needles, syringes and other injecting
equipment by people who inject drugs.
interventions are key to preventing transmission of HCV and other blood-borne
infections such as HIV, among people who inject drugs. Needle exchange or syringe
service programmes promote safe injecting practices by providing
education and access to sterile injecting equipment. These are also a gateway
to HCV/HIV testing, linkage to healthcare and referral to opioid substitution
therapy and substance abuse treatment.
Given the patchy
access to SSPs across the US, investigators examined the geographical
distribution of SSPs in all 50 states relative to the number of young people
The study sample
consisted of 29,382 people, aged between 15 and 29 years, diagnosed with HCV
infection by two commercial laboratories between 2015 and 2016.
calculated the distance between the home addresses of these patients and the
nearest SSP. Proximity to a SSP was arbitrarily defined as “near” for distances
less than ten miles, and as “far” for distances greater than ten miles.
The majority of
patients (54%) were female and the median age was 25 years.
distance from an SSP was 37 miles, with a range of 0 to 667 miles. Overall,
80% of patients lived at least ten miles from their nearest SSP.
Proximity to SSPs
varied considerably. Just over half (53%) of patients in the most urban
counties lived within ten miles of an SSP compared to just 2% of patients in
the most non-urban counties.
varied by region. The proportion of patients living close to an SSP was highest
in the West (36%) and lowest in the South (9%).
estimated that in order to reach 95% of patients currently living far from a
SSP, it would be necessary to establish approximately 2200 new facilities.
“This study showed
that in any region of the country less than half of young people infected with
HCV are located near SSPs,” comment the authors. “The larger gaps in access in
the South and Midwest, suggest that our ability to interrupt HCV transmission
and avert potential epidemics among PWIDs [people who inject drugs] may be most limited in these
They conclude, “addressing
the large gap in access to harm reduction services is paramount for preventing
continued HCV transmission among PWID.”