Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

April Young, PhD, MPH

Committee Member

Wayne Sanderson, PhD, MS

Committee Member

Lorie Chesnut, DrPH, MPH

Committee Member

Douglas Thoroughman, PhD, MS


Objective: Few studies have been conducted in Kentucky to investigate the statewide prevalence of HCV infection and its associated risk factors. The purpose of this study was to examine the factors related to HCV infection in the state, and specifically to investigate geographical differences of HCV infection between those residing in Appalachian vs. Non-Appalachian counties in Kentucky.

Methods: The study sample (n =5205) was selected from a pool of 8300 high-risk individuals participating in a pilot cross-sectional study on HCV conducted by the Kentucky Department for Public Health. The pilot study involved serologically testing participants for antibodies against HCV infection and having participants complete an interview-administered questionnaire at the same time to examine behavioral and socio-demographic characteristics related to HCV infection. Univariate, bivariate, and logistic regression analyses were carried out using SPSS and maps were produced using ArcGIS software. Frequency distribution, adjusted odds ratios (AORs), and corresponding 95% confidence intervals (95% CIs) were reported.

Results: Of the 5205 participants selected (2241 males, 2964 females; mean age, 30.4 ± 10.5 years); 9.8% tested positive for anti-HCV antibodies. Residence in Appalachian vs. Non-Appalachian Kentucky was not significantly associated with HCV antibody status. In the multivariate analysis, Blacks (AOR: 0.42, 95% CI: 0.26 – 0.66) and men who have sex with men (MSM) (AOR: 0.36, 95% CI: 0.17 – 0.73) were significantly less likely to be HCV positive after adjusting for all other variables. HCV seropositivity was positively associated with age (AOR: 1.03, 95% CI: 1.02 – 1.04), history of injection drug use (IDU) (AOR: 41.27, 95% CI: 31.94 – 53.31), and presence of tattoos (AOR: 1.49, 4 95% CI: 1.14 – 1.96). Gender was also found to significantly modify the association between residence and HCV antibody status, specifically in the Appalachian region.

Conclusion: This was the first statewide analysis to examine the prevalence of HCV infection among high-risk population residing in Appalachia vs. Non-Appalachian counties in Kentucky. The main variables associated with HCV infection in these regions were age, Black race, history of IDU, MSM and presence of tattoos. Addressing these risky behaviors and particular populations through age- and gender-specific preventive and treatment measures may reduce the high prevalence of HCV infection in the state of Kentucky. However, more research is required to further characterize HCV-related risk factors with respect to residence in Appalachian vs. Non-Appalachian to determine how these measures can be effectively implemented.

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