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Am J Public Health. 2019 Mar;109(3):445-450. doi: 10.2105/AJPH.2018.304873. Epub 2019 Jan 24.

Estimating the Number of People Who Inject Drugs in A Rural County in Appalachia.

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Sean T. Allen, Rebecca Hamilton White, and Susan G. Sherman are with the Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD. Allison O'Rourke is with the DC Center for AIDS Research, George Washington University, Washington, DC. Kristin E. Schneider is with the Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health. Michael Kilkenny is with the Cabell-Huntington Health Department, Huntington, WV.



To demonstrate how we applied the capture-recapture method for population estimation directly in a rural Appalachian county (Cabell County, WV) to estimate the number of people who inject drugs (PWID).


We conducted 2 separate 2-week periods of data collection in June ("capture") and July ("recapture") 2018. We recruited PWID from a syringe services program and in community locations where PWID were known to congregate. Participants completed a survey that included measures related to sociodemographics, substance use, and HIV and hepatitis C virus prevention.


In total, 797 surveys were completed; of these surveys, 49.6% (n = 395) reflected PWID who reported injection drug use in the past 6 months and Cabell County residence. We estimated that there were 1857 (95% confidence interval = 1147, 2567) PWID in Cabell County. Among these individuals, most reported being White (83.4%), younger than 40 years (70.9%), and male (59.5%). The majority reported injecting heroin (82.0%), methamphetamine (71.0%), and fentanyl (56.3%) in the past 6 months.


Capture-recapture methods can be applied in rural settings to estimate the size of PWID populations.

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