How the rural risk environment underpins hepatitis C risk: Qualitative findings from rural southern Illinois, United States

• Published in: The International journal of drug policy Vol. 112; p. 103930
• Main Authors: Walters, Suzan M., Frank, David, Felsher, Marisa, Jaiswal, Jessica, Fletcher, Scott, Bennett, Alex S., Friedman, Samuel R., Ouellet, Lawrence J., Ompad, Danielle C., Jenkins, Wiley, Pho, Mai T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.02.2023
• Subjects: COVID-19; Drug Users; Hepacivirus; Hepatitis C; Hepatitis C - drug therapy; Humans; Illinois - epidemiology; Injection drug use; Pandemics; Rural risk environment; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; United States - epidemiology; United States; Illinois; Hepatitis C; Rural risk environment; Injection drug use
• ISSN: 0955-3959; 1873-4758
• DOI: 10.1016/j.drugpo.2022.103930

•The Rural Risk Environment Framework focuses on macro forces of disease risk.•The production of hepatitis C risk operates at the economic, physical, policy, and social levels.•Individual hepatitis C risk is related to vulnerabilities produced structurally.•Hepatitis C interventions need to move beyond individual behavioral modification. Hepatitis C virus (HCV) infection has increased among persons who inject drugs (PWID) in the United States with disproportionate burden in rural areas. We use the Risk Environment framework to explore potential economic, physical, social, and political determinants of hepatitis C in rural southern Illinois. Nineteen in-depth semi-structured interviews were conducted with PWID from August 2019 through February 2020 (i.e., pre-COVID-19 pandemic) and four with key informants who professionally worked with PWID. Interviews were recorded, professionally transcribed, and coded using qualitative software. We followed a grounded theory approach for coding and analyses. We identify economic, physical, policy, and social factors that may influence HCV transmission risk and serve as barriers to HCV care. Economic instability and lack of economic opportunities, a lack of physically available HCV prevention and treatment services, structural stigma such as policies that criminalize drug use, and social stigma emerged in interviews as potential risks for transmission and barriers to care. The rural risk environment framework acknowledges the importance of community and structural factors that influence HCV infection and other disease transmission and care. We find that larger structural factors produce vulnerabilities and reduce access to resources, which negatively impact hepatitis C disease outcomes.