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NIDA grant funds MD/PhD student’s study of hepatitis C and injection drug use in rural New England

Eric Romo

A UMass Medical School graduate student recently received the Ruth L. Kirschstein National Research Service Award Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research from the National Institute on Drug Abuse to evaluate the association between distance to sterile syringe source and hepatitis C virus (HCV) infection, exploring health disparities between people living with addiction in rural areas and those where more services are available.

Eric Romo, an MD/PhD student in the Clinical and Population Health Research Program, was awarded a four-year fellowship totaling $167,074 through a funding program aimed at promoting diversity in health-related research by supporting the training of promising predoctoral students from underrepresented groups. Romo’s parents come from Mexico.

Romo’s study looks at access to sterile syringes and HCV infection among people living in rural New Hampshire, Massachusetts and Vermont who inject drugs, using a risk environment framework. This framework proposes that physical, social, economic and policy environments all contribute to the risk of drug-related harms.

Previous studies have shown that programs improving access to sterile syringes among people who inject drugs are associated with a reduction in injection-mediated risks and HIV transmission. But the evidence for whether these services reduce HCV risk remains mixed.

Romo is working with research adviser Peter D. Friedmann, MD, MPH, professor of medicine and associate dean for research at UMMS Baystate Regional Campus.

While much of the focus of researchers and policy makers addressing opioid use disorders has been, rightly, on overdose deaths, Romo said, other harmful consequences such as HCV have also surged during the opioid crisis. Between 2010 and 2015, the incidence of HCV increased by 294 percent nationally. The incidence in rural counties has been reported by the Centers for Disease Control as more than twice that in urban counties.

Romo proposed to address this gap through a mixed-method approach, using data from the Drug Injection Surveillance and Care Enhancement for Rural Northern New England (DISCERNNE) study, a cross-sectional study of 589 adults who use and/or inject drugs, geocoded with address data to calculate their road network distance to the nearest sterile syringe source. Sterile syringe sources include nonprescription sale of syringes in pharmacies and needle exchange programs.

In addition, Romo will evaluate the association between HCV and receptive secondary syringe exchange —a practice in which sterile needles are acquired not by the end user but by someone who distributes them—using data from an audio computer-assisted self-interview (ACASI) survey, as well as data from in-depth interviews with people who inject drugs.

Romo said 22 in-depth interviews have been completed, among participants recruited from the pool of ACASI survey respondents and others through street outreach.

Among 422 people who injected drugs, for whom the research team also had HCV test results, 73 percent tested positive for HCV antibodies.

“We found it’s very prevalent,” Romo said.

Needle exchange programs have been few and far between in the rural New England counties in the DISCERNNE study.

“I think it’s just hard to deliver these services in more rural areas,” he said. “They’ve also had to rely on mobile syringe exchange services where you call a number, and someone can get to you. Some of these rural areas have had to try to do some unique models of delivery.”

Romo said the project is the first of a several efforts to address the needs of people with substance use disorders in rural communities. He is also a research assistant on an intervention in which rural residents who inject drugs and are HCV positive will be treated for their HCV via telehealth on a mobile van. The principal investigators for that study are Dr. Friedmann and Tom Stopka, PhD, MHS, associate professor of public health and community medicine at Tufts University School of Medicine.

“I went to medical school and decided to do research in the first place because I was drawn to help people who are in vulnerable populations,” said Romo. “Substance use disorder touches on every aspect of health care and society. We’re going to have to make advances in health care delivery and we’re going to have to deal with the social determinants of health.”