Implementing HCV Screening in Outreach Settings in North Carolina

Background:  The NC Division of Public Health supports local health departments and community-based organizations to provide HIV testing in non-clinical settings and in substance abuse clinics.  In line with the NC PCSI objectives, testing for other sexually transmitted infections, including Hepatitis C virus, is also provided.  

Objectives:  To describe the outcomes of a HCV screening program in multiple settings throughout North Carolina.  

Methods: During 2010, four agencies provided HCV testing for clients with a history of drug use. In 2011, the number of agencies increased to five.  Data was collected on the number of tests done, the number of positive tests, and the number and outcomes of those linked to clinical care.

Results:  During 2010, 716 persons were tested for HCV in NC Division of Public Health funded agencies, and 45 had reactive tests (6.3%).  Preliminary data for 2011 show a positivity rate of 7.1% (31 positive out of 439 tested). All clients were also tested for HIV and syphilis.  All clients with a positive HCV test were referred to an infectious disease clinic for further clinical evaluation and care.

Conclusions:  Testing in outreach settings in North Carolina identified a high percentage of persons positive for HCV.  Ensuring linkage to care is a challenge for programs that offer HCV testing

Implications for Programs, Policy, and Research:   It is estimated that 3.9 million Americans have been infected with HCV, of which 2.7 million are chronically infected.  Many of these individuals do not have clinical symptoms and are unaware of their infection.  Identifying those who are infected with HCV and linking them to clinical care and harm-reduction programs is a priority.  Referral resources need to increase if HCV testing is to be expanded in NC programs.