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Few young people with HCV in the US live close to needle-exchange services

Michael Carter
11 May 2017

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.

“Our findings 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.

Harm reduction 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 with HCV.

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.

The authors 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.

The median 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.

Proximity also varied by region. The proportion of patients living close to an SSP was highest in the West (36%) and lowest in the South (9%).

The investigators 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 regions.”

They conclude, “addressing the large gap in access to harm reduction services is paramount for preventing continued HCV transmission among PWID.”


Canary L et al. Geographic disparities in access to syringe services programs among young people with hepatitis C virus infection in the US. Clin Infect Dis, online edition, 2017.