Risk Of Hepatitis C Virus Transmission Research Articles

Detachable low dead space syringes for the prevention of hepatitis C among people who inject drugs in Bristol, UK: an economic evaluation.

Traditional detachable syringes used by people who inject drugs (PWID) retain larger volumes of blood when the plunger is depressed than syringes with fixed needles-referred to as high (HDSS) and low dead space syringes (LDSS), respectively. Evidence suggests that using HDSS may result in greater hepatitis C virus (HCV) transmission risk than LDSS. We evaluated the cost-effectiveness of an intervention to introduce detachable LDSS in a needle and syringe programme (NSP). HCV transmission and disease progression model with cost-effectiveness analysis using a health-care perspective. Detachable LDSS are associated with increased costs (£0.008) per syringe, yearly staff training costs (£536) and an estimated decreased risk (by 47.5%) of HCV transmission compared with HDSS. The intervention was modelled for 10years, with costs and health benefits (quality-adjusted life-years: QALYs) tracked over 50years. Bristol, UK. PWID attending NSP. Gradual replacement of HDSS at NSP, with 8, 58 and 95% of HDSS being replaced by detachable LDSS in 2016, 2017 and 2018, respectively. Comparator was continuing use of HDSS. Net monetary benefit. Benefits were measured in QALYs. Introducing detachable LDSS was associated with a small increase in intervention costs (£21 717) compared with not introducing detachable LDSS, but considerable savings in HCV-related treatment and care costs (£4 138 118). Overall cost savings were £4 116 401 over 50years and QALY gains were 1000, with an estimated 30% reduction in new infections over the 10-year intervention period. In all sensitivity analyses, detachable LDSS resulted in cost savings and additional QALYs. Threshold analyses suggested that detachable LDSS would need to reduce HCV transmission risk of HDSS by 0.26% to be cost-saving and 0.04% to be cost-effective. Replacing high dead space syringes with detachable low dead space syringes in needle and syringe programmes in the United Kingdom is likely to be a cost-saving approach for reducing hepatitis C virus transmission.

Evolution of the residual risk of HBV, HCV and HIV transmission through blood transfusion in the Region of Valencia, Spain, during a 15-year period (2003-2017).

Towards the end of the 20th century, transfusion-transmitted viral infections (TTVI) represented a huge problem for public health. From the beginning of the screening of blood donations, this risk has decreased to the point that it is no longer possible to measure it directly and it is necessary to use mathematical models. Using one of these models, the aim of this study was to analyse the evolution of the residual risk of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) transmission through blood transfusion from 2003 to 2017 in the Region of Valencia, Spain. Using data from the Blood Transfusion Centre of the Valencian Community, the incidence rate in donors and the residual risk were calculated for each agent and year by applying the most updated version of the incidence/window period model. For the set of the three viruses, these magnitudes were calculated as the algebraic sum of the specifics ones for each of them. The evolution of both magnitudes was analysed by the Mann-Kendall trend test and the Sen estimation of trend slope. The residual risks obtained vary depending on the agent and the year. Considering the three viruses jointly, they range from 1 per 360,380 to 1 per 44,715 donations. During the study period, there was a statistically significant downward trend in the incidence rate of HBV (p<0.05, trend slope -0.88), the residual risk of HBV (p<0.0005, slope -0.98), and the joint residual risk for the three viruses (p<0.0001, slope -0.99). The current risk of TTVI is very low in the Region of Valencia. In the last 15 years, there has been a reduction in the donor incidence rate and in the residual risk for the case of HBV; such a reduction cannot be confirmed for HCV and HIV. Consideration of the three viruses jointly confirms a reduction in the residual risk; we are unable to establish whether the evolution of the joint incidence rate has contributed to this reduction or whether it is due only to the shortening of window periods.

Screening and linkage to care of prisoners with HCV infection: the RESIST-HCV project

Background: In prisons there are high prevalence of hepatitis C virus (HCV) infection, high rate of PWID and a substantial risk of HCV transmission. Epidemiological studies are needed to evaluate the rate of prisoners with chronic HCV hepatitis and to establish how many of them need Direct Acting Antiviral (DAA) therapy.

Hepatitis C virus seropositivity and the risk factors for transmission among blood donors in some selected centers in Lagos State, Southwest Nigeria

ABSTRACTIntroduction: Hepatitis C virus (HCV) infects about 0.5% to 2.3% of the world population with most of the cases occurring in developing countries. It is primarily transmitted through transfusion of blood and blood products. There exists dearth of information on burden and circulation of HCV and their attendant health challenges in Nigeria. This study was therefore designed to determine the seroprevalence rate and risk of HCV transmission among blood donors in Lagos State Nigeria.Methodology: Blood samples were collected between January 2002 and December 2006 from 3,002 consenting (Male = 2,922; Female = 80; Age range = 18–63; Median age = 32 years) donors in five selected public hospitals’ blood donation centers between 2002 and 2006. Sera was tested for anti-HCV by ELISA technique. Demographic and other relevant information were obtained by a semi-structured questionnaire to assess risk factors for HCV transmission.Results: This study found an overall rate of 3.1% for anti-HCV among the blood donors sampled. Highest rate of 6.0% for HCV was found among participants age ranged ≥50 years and lowest in the age group 40–49 years. Prevalence of HCV was higher in female (6.3%) than in male (3.0%) and was 0.21 times less risky in female compared to their male counterparts (OR = 1.29, 95%CI 0.11–1.31). By location, MSCH had the highest HCV rate (3.9%) and lowest (2.1%) in GHOA. Sharing of sharps for tattoo/tribal markings had a statistical association (p = .0379) with HCV infection. However, no significant difference was found by gender (CI = 0.99–2.01; p = .1002), age (CI = 0.79–1.55; p = .1001) and location (p = .5326).Conclusion: The relatively high prevalence of HCV infection detected and the risk of transmission among blood donors in this study are of public health importance. Hence, the institution of appropriate measures to stem down the trend of HCV circulation among this population in Nigeria is therefore advocated.

The contribution of injection drug use to hepatitis C virus transmission globally, regionally, and at country level: a modelling study

WHO aims to eliminate the hepatitis C virus (HCV) as a public health threat by 2030. Injection drug use is an important risk factor for HCV transmission, but its contribution to country-level and global epidemics is unknown. We estimated the contribution of injection drug use to risk for HCV epidemics globally, regionally, and at country level. We developed a dynamic deterministic HCV transmission model to simulate country-level HCV epidemics among people who inject drugs and the general population. Each country's model was calibrated using country-specific data from UN datasets and systematic reviews on the prevalence of HCV and injection drug use. The population attributable fraction of HCV transmission associated with injection drug use was estimated-defined here as the percentage of HCV infections prevented if additional HCV transmission due to injection drug use was removed between 2018 and 2030. The model included 88 countries (85% of the global population). The model predicted 0·23% (95% credibility interval [CrI] 0·16-0·31) of the global population were injection drug users in 2017, and 8% (5-12) of prevalent HCV infections were among people who currently inject drugs. Globally, if the increased risk for HCV transmission among people who inject drugs was removed, an estimated 43% (95% CrI 25-67) of incident HCV infections would be prevented from 2018 to 2030, varying regionally. This population attributable fraction was higher in high-income countries (79%, 95% CrI 57-97) than in countries of low and middle income (38%, 24-64) and was associated with the percentage of a country's prevalent HCV infections that are among people who inject drugs. Unsafe injecting practices among people who inject drugs contribute substantially to incident HCV infections globally. Any intervention that can reduce HCV transmission among people who inject drugs will have a pronounced effect on country-level incidence of HCV. None.

Residual risk of HIV, HCV, and HBV transmission by blood transfusion between 2015 and 2017 at the Regional Blood Transfusion Center of Ouagadougou, Burkina Faso.

IntroductionIn sub-Saharan Africa, the high endemicity of blood-borne infections is a serious threat to transfusion safety. In order to improve transfusion safety, Burkina Faso has undertaken in recent years a reorganization of its blood-transfusion system through the creation of a National Blood Transfusion Center, which is the only blood operator in the whole country. This study aimed to estimate the residual risk of transmission of HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) by blood transfusion at the Regional Blood Transfusion Center (RBTC) of Ouagadougou.MethodsThis was a retrospective study conducted at the RBTC of Ouagadougou between 2015 and 2017. Prevalence of infectious markers was calculated for first-time donors and incidence rates calculated for repeat donors who had made at least two donations of blood over the study period. Residual risks were estimated for the three viruses (HIV, HBV, and HCV) by multiplying the incidence rate per 100,000 person-years by the respective durations of serological windows.ResultsBetween 2015 and 2017, of a total of 84,299 blood donors, 68,391 (81.13%) were first-time donors compared to 15,908 (18.87%) repeat donors. The seroprevalence of HBV (8.56%) was twice that of HCV (4.40%) and fourfold that of HIV (1.80%). Incidence rates were 1,215, 2,601, and 1,599 per 100,000 donations for HIV, HCV, and HBV, respectively. In contrast, the estimated residual risk for HCV (1 in 213 donations) was double that of HBV (1 in 408 donations) and four times that of HIV (1 in 1,366).ConclusionThe residual risk of transmission of these viruses by blood transfusion remains high in repeat donors. An effective donor-retention and education policy could help to reduce this residual risk.

Hepatitis C virus screening and treatment in Irish prisons from a governor and prison officer perspective - a qualitative exploration

BackgroundPrisons are a key location to access Hepatitis C Virus (HCV) infected people who inject drugs (PWID). Prison health care structures are complex and optimising health care delivery to this high need, marginalised and underserved population remains challenging. Despite international guidelines recommending that prisons are a priority location for HCV screening and treatment levels of prisoner engagement in HCV care remain low. Competing priorities between security and healthcare is a key feature of prison health care. A collaborative approach to health care delivery in prisons can maximise the benefits for prisoners, staff and the wider community.AimTo identify the barriers and enablers to HCV screening and treatment in Irish prisons and inform the implementation of a HCV screening program within the Irish Prison Services (IPS).MethodsQualitative study using focus group methodology underpinned by grounded theory.ResultsThe following themes emerged from the analysis: priority of safety and security, staffing and resources, concerns about personal risk, lack of knowledge, concerns around confidentiality, prisoners’ fear of treatment and stigma, timing of screening, use of peer workers, in-reach hepatology and fibroscanning services. The primary role of prison security is to ensure the safety of staff and prisoners with a secondary but important supporting role in health care delivery. Maintaining adequate staffing levels and the provision of training and education were seen as priorities and impacted on prison officers’ fear for personal safety and risk of HCV transmission. Opt-out screening and peer support workers had high levels of support among participants.ConclusionUpscaling HCV management in prisons requires an in-depth understanding of all barriers and facilitators to HCV screening and treatment. Engaging prison officers in the planning and delivery of health care initiatives is a key strategy to optimising the public health opportunity that prisons provides.

Australia on track to achieve WHO HCV elimination targets following rapid initial DAA treatment uptake: A modelling study.

Subsidized direct-acting antiviral (DAA) treatment recently became available to all adults living with chronic hepatitis C virus (HCV) in Australia. Based on rapid uptake (32600 people initiated DAA in 2016), we estimated the impact on HCV epidemiology and mortality in Australia and determined if Australia can meet the WHO HCV elimination targets by 2030. Using a mathematical model, we simulated pessimistic, intermediate and optimistic DAA treatment scenarios in Australia over 2016-2030. We assumed treatment and testing rates were initially higher for advanced fibrosis and the same across HCV transmission risk level sub-populations. We also assumed constant testing rates after 2016. We compared the results to the 2015 level and a counterfactual (IFN-based) scenario. During 2016-2030, we estimated an intermediate DAA treatment scenario (2016, 32600 treated; 2017, 21370 treated; 201817100 treated; 2019 and beyond, 13680 treated each year) would avert 40420 new HCV infections, 13260 liver-related deaths (15320 in viraemic; -2060 in cured) and 10730 HCC cases, equating to a 53%, 63% and 75% reduction, respectively, compared to the IFN-based scenario. The model also estimated that Australia will meet the WHO targets of incidence and treatment by 2028. Time to a 65% reduction in liver-related mortality varied considerably between HCV viraemic only cases (2026) and all cases (2047). Based on a feasible DAA treatment scenario incorporating declining uptake, Australia should meet key WHO HCV elimination targets in 10 to15years. The pre-DAA escalation in those with advanced liver disease makes the achievement of the liver-related mortality target difficult.

Utilizing Donors with Hepatitis C Antibody Positivity and Negative Nucleic Acid Testing

The demand for organs in the USA exceeds supply resulting in high mortality for patients awaiting transplantation. To increase the pool of available organs, the transplant community is investigating the safety and utility of organs previously considered high risk. Guidelines currently advocate for the use of hepatitis C antibody, nucleic acid testing (NAT)-negative organs in hepatitis C–positive recipients. However, data is limited regarding outcomes of using such grafts in hepatitis C–negative recipients. The purpose of this paper is to review the literature on utilizing hepatitis C virus (HCV)-positive NAT-negative livers and to determine if utilizing direct-acting antivirals lowers the risk of HCV transmission regardless of the recipient’s HCV status. The current literature demonstrates that the overall risk of transmission of HCV with the use of these organs in HCV-negative recipients is low and that risk is increased with high-risk donors that died from IVDA overdose. Direct-acting antivirals are highly effective in treating HCV and lowering the risk of transmission. Therefore, we should reconsider utilizing these organs in HCV-positive recipients.

Hepatitis C virus (HCV) RNA level in plasma and kidney tissue in HCV antibody-positive donors: Quantitative comparison.

Kidney transplant from donors with hepatitis C virus (HCV) antibody has been limited to HCV viremic recipients only, due to concern of the HCV transmission. However, the new antiviral medications provide an opportunity to expand the utilization of these donors. To study the risk of HCV transmission in kidney transplantation, we used discarded donor kidneys and determined HCV RNA levels by quantitative real-time PCR in bilateral (right and left) kidney biopsies and plasma from 14 HCV antibody-positive donors (sensitivity: 15 international unit (IU)/mL plasma; 1.8IU/50nL kidney). In three NAT-negative donors, HCV RNA was negative in plasma and kidney. In all 11 NAT-positive donors, HCV RNA was positive in plasma (range: 5807-19134177IU/mL) but negative in six kidneys from four donors with plasma HCV RNA <1.5million IU/μL. HCV RNA correlated between right and left kidneys (P=0.75) and between kidney and plasma (r=0.86). When normalized by volume, HCV RNA median (range) was 49 (0-957) IU/50nL plasma and 1.0 (0-103) IU/50nL kidney, significantly lower in kidney (P=0.005) than in plasma (14-fold). Plasma HCV RNA can be used to predict the kidney HCV load. Future studies are needed if plasma/kidney HCV levels can be used to stratify donors for transmission risk and recipients for post-transplant management in extended utilization of HCV antibody-positive donors.

Donor‐derived hepatitis C in the era of increasing intravenous drug use: A report of the Disease Transmission Advisory Committee

The opioid epidemic has resulted in a potential increase in donors in the testing window period for hepatitis C virus (HCV). We analyzed HCV reports to the Disease Transmission Advisory Committee (DTAC) between 2008 and 2016 to estimate the risk of HCV transmission. In 15 of 95 (16%) reports, at least one recipient developed proven/probable donor-derived HCV resulting in 32 infected recipients. Seven transmissions occurred during the nucleic acid testing (NAT) window period; four occurred during serological window period. The other four transmission occurred due to human error (3) and false-negative serology (1). All seronegative-exposed liver and lung recipients contracted HCV; 18/21 (86%) kidney and 3/4 (75%) heart recipients developed HCV. Four transmitting donors died of intravenous drug overdose, three in 2016 and one in 2012. Among donors with a history of intravenous drug use (IVDU), drug intoxication as a mechanism of death, or increased risk status, and negative screening HCV testing, the risk of transmission to a recipient was about 1 in 1000. The overall risk of transmitting HCV from NAT-negative donors with IVDU is low and consistent with modeling data. This information may be helpful to clinicians counseling potential recipients offered these organs.

Hampering HCV transmission

Hepatitis C Virus No hepatitis C virus (HCV) vaccine is currently available. Furthermore, evidence from studies in nonhuman primates suggests that any future human HCV vaccine would be unlikely to induce complete immunity. Major et al. examined whether lowered HCV titers potentially resulting from an imperfect vaccine might still stem HCV transmission in people who inject drugs. They measured the HCV RNA from infected human plasma retained in contaminated needles and syringes. Their mathematical model combining these measurements with published data on HCV viral kinetics suggested that a partially effective vaccine could reduce the HCV transmission risk from sharing contaminated needles and syringes. Sci. Transl. Med. 10 , eaao4496 (2018).

Prevalence and outcome of post-transfusion hepatitis C acquired at different ages and detected in look-back screening

Objectives: The prevalence of hepatitis C virus (HCV) infection in Sweden is estimated to 0.5%. Before 1992, blood transfusion posed a risk of HCV transmission. The primary aim of this study was to estimate anti-HCV prevalence in Stockholm County among individuals receiving blood transfusions 1965–1991. The secondary aim was to study the effect of age at transfusion on the development of liver disease and treatment outcome.Materials and methods: This is a retrospective analysis of individuals found to be anti-HCV tested positive in Stockholm County during a national screening campaign in Sweden 2008–2010. All anti-HCV-positive individuals were also HCV RNA tested. Data on age at transfusion, age at diagnosis, HCV genotype, viral load, fibrosis score, liver histology and antiviral treatment were recorded.Results: Out of 7473, 134 (1.8%) tested individuals were anti-HCV positive and 102 were HCV RNA positive resulting in a prevalence of chronic hepatitis C (CHC) of 1.4%. The rate of advanced liver damage was 18% (10/56). Patients younger than 19 years of age at transfusion were significantly more often started on antiviral treatment compared to adult patients, 65% vs 29% p < .001. No significant correlation was found between treatment outcome and gender or age at transfusion.Conclusions: In this study, we found an anti-HCV prevalence of 1.8% which is considerably higher than the estimated prevalence in the Swedish general population (0.5%), and patients infected during childhood were more likely to receive antiviral treatment. Additional data on the HCV epidemic in Sweden are needed regarding prevalence and age distribution.

Hepatitis C Virus Screening Among Children Exposed During Pregnancy.

Because of the opioid epidemic, hepatitis C virus (HCV) infection is increasing among pregnant women, resulting in an increased risk of perinatal transmission and HCV infection among children. Our primary objectives in this study were to determine the prevalence of HCV among pregnant women and the frequency of pediatric HCV screening. A population-based, retrospective cohort of pregnant women who delivered between 2006 and 2014 was identified and classified as HCV infected or HCV uninfected by billing codes. Infant records linked to the HCV-infected pregnant women were identified and queried for HCV tests and the receipt of well-child services, which were defined as the presence of hemoglobin and/or lead testing at or after 9 months of age. Between 2006 and 2014, 1043 (1.2%) HCV-infected pregnant women delivered, and the HCV prevalence increased by 60%. HCV-infected women were more likely to be <30 years of age (67% vs 53%; P < .001), white (93% vs 72%; P < .001), insured by Medicaid (77% vs 29%; P < .001), and have opiate use disorder (68% vs 1%; P < .001) than HCV-uninfected women. Infants born to HCV-infected women were more likely to be preterm (<37 weeks' gestation; 22% vs 10%; P < .001) and of low birth weight (<2500 g; 23% vs 8%; P < .001). Among 1025 HCV-exposed infants with available pediatric records, 323 (31%) received well-child services, and among these, only 96 (30%) were screened for HCV. Despite the increased HCV prevalence among pregnant women and the risk of perinatal HCV transmission, HCV-exposed infants are not adequately screened, and many pediatric HCV infections remain undetected.

Syringe sharing among people who inject drugs in London, Canada.

London, Ontario, is facing an outbreak of HIV among people who inject drugs (PWID), as well as persistently high levels of hepatitis C virus (HCV). Syringe sharing is the primary driver of HIV and HCV transmission risks among PWID, however, little is known about factors contributing to syringe sharing in this setting. Therefore, we sought to characterize syringe sharing and its correlates among London PWID. Between March and April, 2016, PWID participated in a survey administered by peer research associates as part of the Ontario Integrated Supervised Injection Services Feasibility Study. Bivariable and multivariable logistic regression models examined associations with syringe sharing (borrowing or lending previously used syringes) over the previous 6months. A sub-analysis described patterns of borrowing and lending by self-reported HIV and HCV statuses. Of 198 PWID, 44 (22%) reported syringe sharing in the past 6months. In the multivariable analysis, selling drugs (adjusted odds ratio; AOR = 1.92, 95% CI = 1.20-3.08), daily crystal methamphetamine injection (AOR = 1.66, 95% CI = 1.07-2.59), and identifying as HIV-positive (AOR = 3.11, 95% CI = 1.61-6.01) were independently associated with increased syringe sharing. While not independently associated with syringe sharing, problems accessing syringes were common (13-50%). Self-reported HIV-positive respondents were more likely to report syringe borrowing (p < 0.001), but not lending (p = 0.26). We observed a high rate of syringe sharing among London PWID, with sharing being associated with high-intensity injection of crystal methamphetamine, as well as with involvement in drug sales. Considering the current HIV outbreak in London, multi-level prevention efforts are urgently needed.

Hepatitis C transmission from seropositive, nonviremic donors to non-hepatitis C liver transplant recipients.

In this prospective cohort of non-HCV liver recipients receiving grafts from HCV antibody-positive/NAT-negative donors, the incidence of HCV transmission was 16%, with the highest risk conferred by donors who died of drug overdose; given the availability of safe and highly effective antiviral therapies, use of such organs could be considered to expand the donor pool. (Hepatology 2018;67:1673-1682).

Uptake of direct-acting antiviral treatment for chronic hepatitis C in Australia.

A government-funded interferon-free direct-acting antiviral (DAA) treatment programme for chronic hepatitis C virus (HCV) infection has been available in Australia since March 2016. This study assessed the levels and patterns of DAA treatment uptake during March-December 2016 in Australia and described the key features in the development of the programme. All prescriptions in Australia are submitted to the Pharmaceutical Benefits Scheme by dispensing pharmacies. Data on dispensed DAA prescriptions for a longitudinal cohort of individuals, representing a 10% random sample of the Pharmaceutical Benefits Scheme database, were used for estimating DAA treatment uptake and subgroup analyses. The estimated number of 32400 individuals initiated DAA treatment in 2016, equating to 14% of people with chronic HCV infection in Australia. Most commonly prescribed DAA regimens included sofosbuvir/ledipasvir (56%, n=18020), sofosbuvir+daclatasvir (39%, n=12600) and sofosbuvir+other agents (4%, n=1220). Among individuals initiated DAA treatment, 66% (n=21430) were men, 43% (n=13870) were ≤50years old and 36% (n=11670) had cirrhosis. DAA prescriptions were 62% (n=20080) by specialists, 19% (n=6000) by general practitioners (GP) and 20% (n=6320) by other physicians. Proportion of individuals prescribed DAA by GPs increased from 8% to 31% and proportion of individuals ≤50years old increased from 28% to 61% between March and December. In conclusion, rapid treatment scale-up was observed in the first 10months of unrestricted DAA programme in Australia. The proportion of prescriptions by GPs increased over time, important for broadened access. A trend towards younger age treatment suggested the broadening of DAA-treated population, potentially including individuals at higher risk of HCV transmission.

Molecular and epidemiological evidence of patient-to-patient hepatitis C virus transmission in a Scottish emergency department

Transmission of hepatitis C virus (HCV) in the healthcare setting is rare. Routine infection prevention and control measures mean that this should be a preventable 'never event'. To investigate the diagnosis of acute healthcare-associated HCV infection. Epidemiological and molecular investigation of a case of acute HCV infection associated with nosocomial exposure. Detailed investigation of the treatment history of a patient with acute HCV infection identified transmission from a co-attending patient in an emergency department as the likely source; this possibility was confirmed by virus sequence analysis. The precise route of transmission was not identified, though both patient and source had minimally invasive healthcare interventions. Review of infection, prevention and control identified potentially contributory factors in the causal pathway including hand hygiene, inappropriate use of personal protective equipment, and blood contamination of the surface of the departmental blood gas analyser. We provide molecular and epidemiological evidence of HCV transmission between patients in an emergency department that was made possible by environmental contamination. Patients with HCV infection are higher users of emergency care than the general population and a significant proportion of those affected remain unknown and/or infectious. Equipment, departmental design, staff behaviour, and patient risk require regular review to minimize the risk of nosocomial HCV transmission.

Global elimination of hepatitis C virus infection: Progresses and the remaining challenges.

Today, with the introduction of interferon-free direct-acting antivirals and outstanding progresses in the prevention, diagnosis and treatment of hepatitis C virus (HCV) infection, the elimination of HCV infection seems more achievable. A further challenge is continued transmission of HCV infection in high-risk population specially injecting drug users (IDUs) as the major reservoir of HCV infection. Considering the fact that most of these infections remain undiagnosed, unidentified HCV-infected IDUs are potential sources for the rapid spread of HCV in the community. The continuous increase in the number of IDUs along with the rising prevalence of HCV infection among young IDUs is harbinger of a forthcoming public health dilemma, presenting a serious challenge to control transmission of HCV infection. Even the changes in HCV genotype distribution attributed to injecting drug use confirm this issue. These circumstances create a strong demand for timely diagnosis and proper treatment of HCV-infected patients through risk-based screening to mitigate the risk of HCV transmission in the IDUs community and, consequently, in the society. Meanwhile, raising general awareness of HCV infection, diagnosis and treatment through public education should be the core activity of any harm reduction intervention, as the root cause of failure in control of HCV infection has been lack of awareness among young drug takers. In addition, effective prevention, comprehensive screening programs with a specific focus on high-risk population, accessibility to the new anti-HCV treatment regimens and public education should be considered as the top priorities of any health policy decision to eliminate HCV infection.

State HCV Incidence and Policies Related to HCV Preventive and Treatment Services For Persons Who Inject Drugs — United States, 2015–2016

Hepatitis C is associated with more deaths in the United States than 60 other infectious diseases reported to CDC combined. Despite curative hepatitis C virus (HCV) therapies and known preventive measures to interrupt transmission, new HCV infections have increased in recent years (1,2). Injection drug use is the primary risk factor for new HCV infections (2). One potential strategy to decrease the prevalence of HCV is to create and strengthen public health laws and policies aimed specifically at reducing transmission risks among persons who inject drugs. To evaluate factors affecting access to HCV preventive and treatment services, CDC assessed state laws governing access to safe injection equipment and Medicaid policies related to sobriety requirements for approval of HCV treatment for persons who inject drugs. Acute HCV incidence rates were obtained from CDC's National Notifiable Disease Surveillance System (NNDSS). States were categorized based on analysis of laws related to access to clean needles and syringes and Medicaid HCV treatment policies associated with sobriety requirements. In 2015, HCV incidence remained high in the United States, with rates in 17 states exceeding the national average. Three states were determined to have state laws and Medicaid policies capable of comprehensively preventing and treating HCV among persons who inject drugs. Opportunities exist for states to adopt laws and policies that could help increase access to HCV preventive and treatment services reducing the number of persons at risk for HCV transmission and disease.