{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T09:26:55Z","timestamp":1782552415748,"version":"3.54.5"},"reference-count":18,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["CDC-RFA-PS17-1703"],"award-info":[{"award-number":["CDC-RFA-PS17-1703"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Predictors for HIV-IDU cases and acute HCV cases differed. The percentage of the county population aged 18\u201324 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\u201324 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0301442","type":"journal-article","created":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:47:07Z","timestamp":1715276827000},"page":"e0301442","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Opioid and other drug use and drug-related mortality as indicators of Hepatitis C and Human Immunodeficiency Virus in Oklahoma"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8670-7730","authenticated-orcid":true,"given":"Aaron M.","family":"Wendelboe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8235-167X","authenticated-orcid":true,"given":"Ozair H.","family":"Naqvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5068-9227","authenticated-orcid":true,"given":"Mary","family":"Williams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Hollen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlin","family":"McGrew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrainia","family":"Harris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann F.","family":"Chou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,9]]},"reference":[{"issue":"3","key":"pone.0301442.ref001","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1177\/00333549211007168","article-title":"Geographic Differences and Social Determinants of Health Among People With HIV Attributed to Injection Drug Use, United States, 2017","volume":"137","author":"C Jin","year":"2022","journal-title":"Public Health Rep"},{"issue":"12","key":"pone.0301442.ref002","doi-asserted-by":"crossref","first-page":"e1192","DOI":"10.1016\/S2214-109X(17)30375-3","article-title":"Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review","volume":"5","author":"L Degenhardt","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"Suppl 5","key":"pone.0301442.ref003","doi-asserted-by":"crossref","first-page":"S239","DOI":"10.1093\/infdis\/jiaa112","article-title":"Responding to Outbreaks of Human Immunodeficiency Virus Among Persons Who Inject Drugs-United States, 2016\u20132019: Perspectives on Recent Experience and Lessons Learned","volume":"222","author":"SB Lyss","year":"2020","journal-title":"J Infect Dis"},{"issue":"3","key":"pone.0301442.ref004","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1111\/j.1465-3362.2011.00291.x","article-title":"The prescription drug epidemic in the United States: a perfect storm","volume":"30","author":"JC Maxwell","year":"2011","journal-title":"Drug Alcohol Rev"},{"key":"pone.0301442.ref005","volume":"33","author":"Centers for Disease Control and Prevention","year":"2020","journal-title":"HIV Surveillance Report"},{"issue":"2","key":"pone.0301442.ref006","doi-asserted-by":"crossref","first-page":"175","DOI":"10.2105\/AJPH.2017.304132","article-title":"Increases in Acute Hepatitis C Virus Infection Related to a Growing Opioid Epidemic and Associated Injection Drug Use, United States, 2004 to 2014.","volume":"108","author":"JE Zibbell","year":"2018","journal-title":"Am J Public Health."},{"key":"pone.0301442.ref007","author":"Centers for Disease Control and Prevention","year":"2020","journal-title":"U.S. Opioid Dispensing Rates, 2020"},{"issue":"3","key":"pone.0301442.ref008","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1056\/NEJMoa1515195","article-title":"HIV Infection Linked to Injection Use of Oxymorphone in Indiana, 2014\u20132015","volume":"375","author":"PJ Peters","year":"2016","journal-title":"N Engl J Med"},{"issue":"16","key":"pone.0301442.ref009","first-page":"443","article-title":"Community Outbreak of HIV Infection Linked to Injection Drug Use of Oxymorphone\u2014Indiana, 2015.","volume":"64","author":"C Conrad","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"3","key":"pone.0301442.ref010","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/QAI.0000000000001098","article-title":"County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States.","volume":"73","author":"MM Van Handel","year":"2016","journal-title":"J Acquir Immune Defic Syndr."},{"issue":"10","key":"pone.0301442.ref011","first-page":"34","article-title":"Measuring Community Vulnerability to Natural and Anthropogenic Hazards: The Centers for Disease Control and Prevention\u2019s Social Vulnerability Index","volume":"80","author":"BE Flanagan","year":"2018","journal-title":"J Environ Health"},{"key":"pone.0301442.ref012","author":"Centers for Disease Control and Prevention","year":"2020","journal-title":"Hepatitis C Surveillance 2020"},{"key":"pone.0301442.ref013","author":"Centers for Disease Control and Prevention","year":"2021","journal-title":"Estimated HIV incidence and prevalence in the United States, 2015\u20132019: HIV Surveillance Supplemental Report;"},{"issue":"11","key":"pone.0301442.ref014","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1093\/cid\/cix1079","article-title":"Tennessee\u2019s In-state Vulnerability Assessment for a \"Rapid Dissemination of Human Immunodeficiency Virus or Hepatitis C Virus Infection\" Event Utilizing Data About the Opioid Epidemic.","volume":"66","author":"M Rickles","year":"2018","journal-title":"Clin Infect Dis"},{"key":"pone.0301442.ref015","doi-asserted-by":"crossref","first-page":"106040","DOI":"10.1016\/j.ypmed.2020.106040","article-title":"A vulnerability assessment for the HCV infections associated with injection drug use.","volume":"134","author":"N Sharareh","year":"2020","journal-title":"Prev Med"},{"key":"pone.0301442.ref016","author":"S Munnangi","year":"2023","journal-title":"Epidemiology Of Study Design. StatPearls. Treasure Island (FL)"},{"key":"pone.0301442.ref017","article-title":"Oklahoma county-level Vulnerability for an HIV\/HCV Outbreak among Persons Who Inject Drugs","author":"L. Yearout","year":"2016","journal-title":"Oklahoma State Department of Health"},{"key":"pone.0301442.ref018","article-title":"Drugs, and Health. Reports of the Surgeon General","author":"Facing Addiction in America: The Surgeon General\u2019s Report on Alcohol","year":"2016","journal-title":"Washington (DC)"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T17:47:15Z","timestamp":1715276835000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301442"}},"subtitle":[],"editor":[{"given":"Oyelola A.","family":"Adegboye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,9]]},"references-count":18,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0301442","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,9]]}}}