Background: Research has shown that syringe exchange programs can facilitate screening for hepatitis C virus (HCV) among people who inject drugs (PWID). Syringe exchange programs are relatively uncommon in non-urban settings, and whether limited access to such programs affects HCV testing for PWID in rural communities is unknown. The goal of this study was to determine whether travel distance to syringe exchange programs affects HCV testing among PWID.
Methods: We used respondent-driven sampling to recruit PWID from a multi-site syringe exchange program in Wisconsin. All participants completed a computerized questionnaire to gather information about previous HCV testing and place of residence. We used geocoded addresses and Google Maps to estimate driving distances between home addresses and the nearest syringe exchange program. Multiple logistic regression was used to estimate the association between travel distance and the odds of being tested for HCV among rural- and urban-dwelling participants, while adjusting for the confounding influences of age, gender, drug use intensity and access to health care.
Results: A total of 235 PWID were enrolled. The sample was 77% male, 36% non-white, 86% reported predominantly injecting heroin, and 70% reported previously being tested for HCV. Overall, no relationship was observed between travel distance and previous HCV testing. However, we found that the relationship between travel distance and being tested differed significantly between urban and rural participants. Among 74 participants residing outside of Milwaukee County, the state’s major urban center, the odds of being tested for HCV decreased by one-third for every 10 mile increase in travel distance to a syringe exchange program (adjusted odds ratio (aOR): 0.67, 95% CI: 0.51-0.87). Other factors independently associated with receiving an HCV test included female gender (aOR 5.00, 95% CI: 1.1-23.6) and having a relationship with a primary care provider (aOR: 4.4, 95% CI:1.0-20.1).
Conclusion: Geographic inaccessibility of syringe exchange programs appears to pose a significant barrier to HCV screening for rural-dwelling PWID. Additional research is needed to develop HCV screening strategies that are responsive to unique challenges in rural communities.