Identifying Areas with Disproportionate Local Health Department Services Relative to Opioid Overdose, HIV and Hepatitis C Diagnosis Rates: A Study of Rural Illinois.

Colleen Mcluckie,Wiley Jenkins,Kaitlin Ellis,Livia Navon,Christofer Rodriguez,Marynia Kolak,Whitney Zahnd,Kelly Walblay,John Schneider,Mai Pho,Yen-Tyng Chen

doi:10.3390/ijerph16060989

Abstract

Background: U.S. rural populations have been disproportionately affected by the syndemic of opioid-use disorder (OUD) and the associated increase in overdoses and risk of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission. Local health departments (LHDs) can play a critical role in the response to this syndemic. We utilized two geospatial approaches to identify areas of discordance between LHD service availability and disease burden to inform service prioritization in rural settings. Methods: We surveyed rural Illinois LHDs to assess their OUD-related services, and calculated county-level opioid overdose, HIV, and hepatitis C diagnosis rates. Bivariate choropleth maps were created to display LHD service provision relative to disease burden in rural Illinois counties. Results: Most rural LHDs provided limited OUD-related services, although many LHDs provided HIV and HCV testing. Bivariate mapping showed rural counties with limited OUD treatment and HIV services and with corresponding higher outcome/disease rates to be dispersed throughout Illinois. Additionally, rural counties with limited LHD-offered hepatitis C services and high hepatitis C diagnosis rates were geographically concentrated in southern Illinois. Conclusions: Bivariate mapping can enable geographic targeting of resources to address the opioid crisis and related infectious disease by identifying areas with low LHD services relative to high disease burden.

Highlights

The United States is in the midst of a syndemic of opioid-use disorder (OUD), overdose and injection drug-related hepatitis C virus (HCV) infection incidence, with increased risk of human immunodeficiency virus (HIV) among people who inject drugs (PWID) [1]
Counties were the units of analysis as they serve as proxies for policy boundaries and most Local health departments (LHDs) in Illinois serve individual counties
We developed bivariate choropleth maps to show the relationship between provision of LHD

Summary

Introduction

The United States is in the midst of a syndemic of opioid-use disorder (OUD), overdose and injection drug-related hepatitis C virus (HCV) infection incidence, with increased risk of human immunodeficiency virus (HIV) among people who inject drugs (PWID) [1]. Where, during 2014–2015, 181 new cases of HIV were diagnosed primarily among a network of PWID, most of whom were co-infected with HCV [5] Both the Centers for Disease Control and Prevention (CDC) and the National Association of County and City Health Officials have provided guidance with recommendations for state and local health departments (LHDs) on how to address this syndemic. These include strengthening surveillance and the provision of prevention and intervention services related to OUD, hepatitis C and HIV [2,6]. Results: Most rural LHDs provided limited OUD-related services, many

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Discussion

Conclusion