Patterns of HIV, hepatitis C, and sexually transmitted infections (STI) co-infection among rural people who inject drugs in the context of an ongoing HIV outbreak

PROJECT SUMMARY Cabell County, West Virginia has been experiencing an ongoing HIV outbreak linked to injection drug use since 2018 among people who inject drugs (PWID), driven by both syringe sharing and unprotected sex. Little attention has been paid to other infectious diseases that share transmission pathways in the context of this outbreak. Thus, we propose to examine HIV, Hepatitis C, syphilis, gonorrhea, and chlamydia co-infection patterns, identify correlates of co- infection (Aim 1), and assess associations with health-related quality of life (Aim 2) among an existing cohort of 400 rural PWID in Cabell County. We will further explore the decision-making processes of PWID who engage in risk behaviors with known HIV+ partners to identify psychosocial targets for future interventions to prevent infectious disease transmission (Aim 3). To achieve the study goals, we propose conduct Hepatitis C and STI (syphilis, gonorrhea, and chlamydia) testing at the 9 and 12 month follow up visits of the HEARTS of WV study (R01DA059335) to supplement existing HIV testing procedures. We will then conduct a latent class analysis of co-infection profiles using the infectious disease testing results. We will conduct a latent class regression analysis to assess sociodemographic, behavioral, and social network correlates of co-infection profiles. We will then use structural equation modeling to estimate the total, direct, and indirect effects through infectious disease treatment engagement on health-related quality of life. We will then conduct 30 in-depth qualitative interviews with PWID who report engaging in syringe sharing or unprotected sex with known HIV+ partners around their decision making processes for doing so to identify modifiable influences to inform future intervention. This proposal will address key gaps in the existing literature by approaching co-infection holistically among PWID, as most co-infection research to date has focused on a single disease parings or transmission pathway (e.g., sexual risk). Findings from Aim 3 in depth interviews will be used to inform future intervention development and implementation by our local partners at the Cabell Huntington Health Department to reduce disease spread. Importantly, the study activities will all occur within the context of an active HIV outbreak which are increasingly common occurrence in rural communities due to the ongoing opioid crisis, making this a high priority context to study to inform future response strategies.