Rapid Hepatitis C Testing Among Persons at Increased Risk for Infection

Morbidity & Mortality Weekly Report

Rapid Hepatitis C Testing Among Persons at Increased Risk for Infection —

Lauren J. Stockman, MPH, Sheila M. Guilfoyle, Andrea L. Benoit, James M. Vergeront, MD, Jeffrey P. Davis, MD

Morbidity and Mortality Weekly Report. 2014;63(14):309-311.

Discussion Only
Introduction

As a tool for enhanced surveillance in Wisconsin, use of the rapid HCV test facilitated screening at four agencies where predominantly young persons at increased risk for HCV infection receive outreach testing, syringe exchange, and other harm reduction services. Most persons who inject drugs acquire HCV infection during their first years of injecting, and sharing of injection equipment has been found to be the most important behavior associated with infection.[3,9] The prevalence of HCV infection among program participants was 20%. Results of previous studies have demonstrated higher prevalence of HCV infection among persons who inject drugs in the United States (range = 35%–65%).[9] However, participants in this program were tested within agencies offering harm reduction services and, therefore, might exhibit safer injection practices or more preventive behaviors compared with other persons who inject drugs.

A majority (70%) of the HCV infections detected during this program were active, viremic infections. This finding, coupled with self-reported behaviors of recent and continued sharing of injection equipment despite participation in a syringe exchange service, is concerning. These data suggest that prevention messages that emphasize the risk for HCV transmission during the sharing of any injection equipment (not only syringes) are highly important. All-oral therapeutic regimens with shorter duration and fewer adverse effects are now available to cure HCV infection and reduce the risk for transmission. Efforts to link persons with viremia to medical care are critical to limit the spread and impact of hepatitis C in Wisconsin.

Although use of the rapid HCV test provides a result at the point-of-visit, additional tests are needed to differentiate past infections from current infections. Therefore, HCV antibody surveillance strategies also should include the collection of blood specimens for RNA diagnostic testing. In the current program, venous blood specimens were obtained from 78% of participants with positive results from rapid HCV tests. The number of specimens collected to confirm current HCV infection might be increased, where practical, with additional training in venipuncture at each agency and enhancement of messages informing clients of the importance of HCV testing and knowledge of the test results.

The findings in this report are subject to at least three limitations. First, although rapid HCV tests were readily available, they were not accepted by all clients at the four agency sites, and data regarding rates of refusal of the rapid tests were not collected systematically. Second, efforts were made by each agency to refer clients with positive HCV test results to medical services; however, data regarding linkage to treatment of acute HCV infection were not collected systematically. Such data are essential to help determine where efforts to improve access to treatment might be needed. Finally, populations served by the four agencies might not be representative of the general Wisconsin population, which might account for all or part of the demographic differences between the HCV-positive population in Wisconsin and the persons with positive HCV test results in this pilot program.

During this pilot program, a rapid HCV test was used to increase HCV awareness and diagnose HCV infections within the context of supportive and accessible community public health programs. This partnership of state public health and community organizations can play an important role in efforts to decrease HCV infections among young persons who inject drugs. Recent evidence suggests that availability of HCV detection services in integrated care settings that combine substance abuse treatment and injection safety is most effective at reducing HCV infection among persons who inject drugs.[10] The use of rapid HCV tests could be a powerful tool for screening, conveying prevention information, and initiating treatment in this population with a high prevalence of HCV infection.

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