Hepatitis C Rapid Antibody Testing Among At-Risk Populations, Arizona, 2014

Felicia McLeanPublic Health Associate

Office for State, Tribal, Local and Territorial SupportCenters for Disease Control and Prevention

Public Health Associate Program's Summer TrainingJune 3 2015

Centers for Disease Control and Prevention

Office for State, Tribal, Local and Territorial Support

Background Information

4.4 Million Americans are living with chronic hepatitis, which includes an estimated 80,000 Arizonans living with hepatitis C.

75% of those with hepatitis are unaware of the infection

Viral hepatitis is one of the most common infectious diseases in Arizona

Hepatitis C is the leading cause of liver cancer and liver transplants

Reports of Hepatitis C by Year, Arizona, 1998-2006

Estimates of People with Hepatitis C in Arizona

NHANES Adjust for Excluded Groups0

10,00020,00030,00040,00050,00060,00070,00080,00090,000

Population age ≥18 in Arizona is 4,763,003

Hepatitis C

United States Census Bureau 2010: Age and Sex Compositions (http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf; accessed 7/23/14); Ditah et al. J Hepatology 2014; 60:691 - NHANES HCV survey found 1.3% prevalence anti-HCV in US population age >18; Chak et al. Liver International 2011; 31:1090 - Adjustment for groups excluded from NHANES including homeless, incarcerated, active military and nursing home residents

Num

ber P

eopl

e w

ith R

eacti

ve a

nti-H

CV A

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dy

Hepatitis C What is Hepatitis C?

Inflammation of the liver caused by the Hepatitis C Virus (HCV) Bloodborne pathogen Acute and chronic forms

How is it transmitted? Injection drug use Blood transfusion or organ transplant (before 1992) Recipient of clotting factor concentrates (made before 1987) Needle sticks or sharp instrument exposures Sharing items such as razors or toothbrushes with an infected person

Hepatitis C Symptoms

• Only 10-25% have symptoms when first infected– Fever– Fatigue– Loss of appetite– Nausea– Vomiting– Abdominal pain– Dark urine– Clay-colored bowel movements– Joint pain– Jaundice (yellow color in the

skin or eyes)

• Usually no symptoms until (or unless) the liver is seriously damaged – may be 10 to 30 years after

infection• More rapid progression may

occur if coinfected with HIV

Who Should be Tested? Anyone born between 1945-1965 Injection drug users- past or present Anyone who received a blood transfusion before 1992 HIV positive persons Recipients of non-professional tattoos or piercings Born to a mother with hepatitis C Abnormal liver test Health care workers

U.S. Preventive Services Task Force (USPSTF) Final Recommendation

Screening for Hepatitis C Virus Infection in Adults Adults at high risk for hep C infection should be screened Health care professionals should offer 1-time hep C screening to adults

born b/w 1945 and 1965 Make up 75% of all people infected in the U.S. This age group at highest risk than other age groups

Became available free of cost as a preventive service for individuals under the Affordable Care Act in June 2014

Available upon request to many people with health insurance, including Medicare

HCV Rapid Antibody Testing Project

* Target population: Injection drug users (IDU)

Quarterly Reporting Form

Preliminary Analysis, 2014

• 215 HCV rapid tests were conducted– 43 were HCV rapid positive

• 39 patients were referred for confirmatory testing– 16 confirmatory tests were conducted

» 6 were HCV confirmed cases and were referred to healthcare

Male; 26; 60%

Female; 17; 40%

Gender Distribution of those Reactive, n = 43

Male; 124; 58%

Female; 89; 41%

Unreported; 2; 1%

Gender Distribution of those Tested, N = 215

HCV Rapid Testing and Results by Gender

18-24 25-34 35-44 45-54 55-64 65 or older0

2

4

6

8

10

12

5

9 10 11

8

0

Number of HCV Rapid Antibody Reactive by Age, n = 43

Reactivity by Age Group18-24: 11% (5/44)25-34: 10% (9/86)35-44: 27% (10/37)45-54: 37% (11/30)55-64: 62% (8/13)≥65: 0% (0/2)

HCV Rapid Testing and Results by Age

18-24 25-34 35-44 45-54 55-64 65+ Unreported0

102030405060708090

100

44

86

3730

13

2 3

Number of those Tested by Age,N = 215

Black; 4; 2%

White; 121; 56%Hispanic; 38; 18%

Asian; 4; 2%

Native Amer-ican; 40; 19%

Unreported; 4; 2% Other; 4; 2%

Race Distribution of those Tested, N = 215

White; 15; 35%

Hispanic; 8; 19%Black; 2; 5%Asian; 1; 2%

Native Amer-ican; 15; 35%

Other; 2; 5%Race Distribution of those Reactive, n = 43

HCV Rapid Testing and Results by Race

HCV Positive

Partner

History

of STD

MSM

Injected

Drugs

Snorte

d Drugs

Non-IDU ex

posure

to blood

Incarcer

ation

Non- pro

fessio

nal tatt

oo or body p

iercin

g

Abnormal

Liver

test

Clotting fact

ors befo

re 1987

0

5

10

15

20

25

30

35

40

9 72

37 36

15

31

15

61

Number of HCV Rapid Antibody Reactive, Risk Factors*, n = 43

*Not mutually exclusive or patients may have multiple risk factors

Risk Factor: Injection Drug Use

Yes; 178; 83%

No; 37; 17%

IDU Among Tested Population, N = 215

Yes; 37; 86%

No; 6; 14%

IDU Among Reactive Population,n = 43

Risk Factor: Intranasal Drug Use

Yes; 168; 78%

No; 47; 22%

Intranasal Drug Use of Tested Population, N = 215

Yes; 36; 84%

No; 7; 16%

Intranasal Drug Use Among Reactive Popu-lation, n = 43

Risk Factor: Incarceration

Yes; 31; 72%

No; 12; 28%

Incarceration Among Tested Population, N = 215

Incarceration Among Reactive Population, n = 43

Yes; 122; 57%No; 93; 43%

Conclusion

Preliminary analysis indicates a high HCV seroprevalence among IDUs, intranasal drug users, and incarcerated individuals

Continuum of HCV care is sub-optimal Only 41% of reactive clients received a confirmatory PCR test Although all 6 HCV confirmed clients were linked to care, there is

limited resources to obtain data on PCR confirmatory test results and to monitor the full continuum of care

Although HCV rapid testing was targeted towards IDUs, a high percentage of reactive clients were those ages 45-64

Implications Continue to test at-risk populations

Baby boomers Injection drug users and intranasal drug users Incarcerated individuals (past and present)

Develop resource directory Local Hepatologists/GI Specialists Federally Qualified Health Centers

Increase public and provider knowledge CDC Recommendations Fact sheet

Support the need to fund future testing programs Promote the National Viral Hepatitis Action Plan objectives

• Increase the proportion of persons living with HCV infection who are made aware of their HCV infection status by testing high-risk populations

Acknowledgments

ADHS Clarisse Tsang Mohammed Khan

HCV Rapid Testing Sites TERROS Pascua Yaqui Tribe Southwest Center for HIV and AIDS

For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support

4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: OSTLTSfeedback@cdc.gov Web: http://www.cdc.gov/stltpublichealth

The findings and conclusions in this presentation are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Felicia McLean: ypj9@cdc.gov

Centers for Disease Control and Prevention

Office for State, Tribal, Local and Territorial Support

Questions?