# Opioid and other drug use and drug-related mortality as indicators of Hepatitis C and Human Immunodeficiency Virus in Oklahoma

## TL;DR

This study explores how drug use patterns and demographics in Oklahoma counties relate to new cases of Hepatitis C and HIV linked to injection drug use.

## Contribution

The study introduces a vulnerability index to identify county-level risk factors for IDU-associated HCV and HIV.

## Key findings

- Population density and education levels are key predictors of new HIV-IDU cases.
- Demographic factors like race and age are more predictive of acute HCV cases.
- Public health strategies should be tailored to address distinct risk profiles for HCV and HIV.

## Abstract

Outbreaks of injection drug use (IDU)-associated infections have become major public health concerns in the era of the opioid epidemic. This study aimed to (1) identify county-level characteristics associated with acute HCV infection and newly diagnosed IDU-associated HIV in Oklahoma and (2) develop a vulnerability index using these metrics.

This study employs a county-level ecological design to examine those diagnosed with acute or chronic HCV or newly diagnosed IDU-associated HIV. Poisson regression was used to estimate the association between indicators and the number of new infections in each county. Primary outcomes were acute HCV and newly diagnosed IDU-associated HIV. A sensitivity analysis included all HCV (acute and chronic) cases. Three models were run using variations of these outcomes. Stepwise backward Poisson regression predicted new infection rates and 95% confidence intervals for each county from the final multivariable model, which served as the metric for vulnerability scores.

Predictors for HIV-IDU cases and acute HCV cases differed. The percentage of the county population aged 18–24 years with less than a high school education and population density were predictive of new HIV-IDU cases, whereas the percentage of the population that was male, white, Pacific Islander, two or more races, and people aged 18–24 years with less than a high school education were predictors of acute HCV infection. Counties with the highest predicted rates of HIV-IDU tended to be located in central Oklahoma and have higher population density than the counties with the highest predicted rates of acute HCV infection.

There is high variability in county-level factors predictive of new IDU-associated HIV infection and acute HCV infection, suggesting that different public health interventions need to be tailored to these two case populations.