Higher HCV Rates, Lower Buprenorphine Prescriptions in Rural Counties in Ohio

White houses and picket fences.
Investigators compared rates of hepatitis C virus infection and office-based buprenorphine prescribing among rural and urban communities.

Compared with urban counties, rural counties in Ohio were found to have twice the rate of acute hepatitis C virus (HCV) infections and less office-based buprenorphine prescribing, as well as a similar relationship between buprenorphine prescribing and overall HCV case rates, according to the results of a descriptive ecological study published in Open Forum Infectious Disease. Prior research has shown that prescribing buprenorphine for individuals with opioid use disorder can prevent HCV infections by reducing the frequency of opioid injections.

Investigators collected data on acute and total HCV incidence by county from the Ohio Department of Health from 2013 to 2017. Acute HCV was defined as an infection detected within the past 6 months, and total HCV was defined as a combination of acute and chronic HCV cases. Data on office-based buprenorphine prescriptions were self-reported by physicians via a survey, and the Investigators calculated the prevalence of office-based buprenorphine prescribing capacity and frequency from January to March 2018.

Counties were categorized as rural or urban based on 2010 US Census data; 38 urban and 50 rural counties were included in the analysis. The median acute HCV rate from 2013 to 2017 was 2.6 times higher in rural counties than in urban counties (10.72 vs 4.16 per 100,000 population). Median total HCV rates were similar between rural and urban counties (550.65 vs 577.36 per 100,000 population).

From January to March 2018, median office-based buprenorphine prescribing capacity was 2.6 times higher in urban vs rural counties (10.25 vs 3.95 patients per 1000 population); office-based buprenorphine prescribing frequency was 3.8 times higher in urban vs rural counties (6.63 vs 1.76 patients per 1000 populations), as well. The prevalence of office-based buprenorphine prescribing frequency and capacity was similar between urban and counties (75% vs 77%, respectively).

The study was likely biased by assuming that physicians prescribed office-base buprenorphine only for their licensed patient capacity and location, and that physicians were knowledgeable about HCV rates in their licensed county. Additionally, all cases of HCV in the study model were used as a proxy for the HCV cases associated with opioid use; however, that was likely not true for all the cases.

The investigators only observed an association between office-based buprenorphine prescribing capacity and frequency and total HCV rates. Urban counties appeared more able to prevent acute HCV cases since they have more office-based buprenorphine prescribing. Although HCV used to be associated with urban populations who injected opioids and had decreased access to health care, today these are characteristics of rural populations. Additionally, stigma associated with drug use is stronger in rural areas than urban ones and presents a barrier to treatment.

“To adequately prevent and control HCV outbreaks, rural counties may need more office-based buprenorphine prescribing in areas with high HCV case rates,” the study authors concluded.


Brook DL, Hetrick AT, Chettri SR, et al. The relationship between hepatitis C virus rates and office-based buprenorphine access in Ohio. Open Forum Infect Dis. Published online May 17, 2021. doi:10.1093/ofid/ofab242