BACKGROUND: Controlling hepatitis C virus (HCV) transmission among people who inject drugs (PWID) has focused on preventing sharing syringes and drug preparation paraphernalia, but it is unclear whether HCV incidence linked to sharing paraphernalia reflects contamination of the paraphernalia or syringe-mediated contamination when drugs are shared. METHODS: In experiments designed to replicate real-world injection practices when drugs are shared, the residual contents of HCV-contaminated syringes with detachable or fixed needled were passed through the "cookers" and filters used by PWID in preparing drugs for injection and then introduced into a second syringe. All items were tested for the presence of infectious HCV using a chimeric HCV with a luciferase gene. RESULTS: Hepatitis C virus could not be recovered from cookers regardless of input syringe type or cooker design. Recovery was higher when comparing detachable needles to fixed needles for residue in input syringes (73.8% vs 0%), filters (15.4% vs 1.4%), and receptive syringes (93.8% vs 45.7%). CONCLUSIONS: Our results, consistent with the hypothesis that sharing paraphernalia does not directly result in HCV transmission but is a surrogate for transmissions resulting from sharing drugs, have important implications for HCV prevention efforts and programs that provide education and safe injection supplies for PWID populations.

Addiction Research Centre Utrecht the Netherlands

Department of Addictology 1st Faculty of Medicine Charles University and General University Hospital Prague the Czech Republic

Department of Anthropology University of Colorado Denver

Department of Microbial Pathogenesis Yale University School of Medicine New Haven Connecticut

Department of Pediatrics Yale University School of Medicine New Haven Connecticut

Department of the Epidemiology Microbial Diseases Yale University School of Public Health New Haven Connecticut

Freudenthal Institute for Science and Mathematics Education Utrecht the Netherlands

Erratum In

J Infect Dis. 2018 Jan 30;217(4):681. doi: 10.1093/infdis/jix671. PubMed

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