Rapid Screenings Detect Previously Unreported HCV Infections

Diedtra Henderson

April 11, 2014

The combination of being able to take needle-stick blood samples outside of the typical clinical setting and rapid screening tests has revealed previously unreported hepatitis C virus (HCV) infections in Wisconsin. These are techniques that could be leveraged across the nation as the number of young drug users with HCV infections has spiked, according to a new study.

Some 3.2 million people in the United States have chronic HCV, an infection that can go unnoticed for years, Lauren J. Stockman, MPH, from the Wisconsin Division of Public Health, Madison, and coauthors write in an article published in the April 11 issue of the Morbidity and Mortality Weekly Report. Yet lifelong HCV infections can have serious consequences, including liver cancer or a need for liver transplantation.

The authors report that in Wisconsin, HCV infections among people younger than 30 years rose from 15 to 54 cases per 100,000 between 2003 and 2012, the authors write.

A pilot study run by the Wisconsin Division of Public Health offered rapid testing at four agencies that also provided needle exchange and counseling for people dependent on illicit drugs. Of 1255 people tested, the rapid screening delivered 246 positive results. Of that group, 192 people provided blood for additional screening, and reverse transcription-polymerase chain reaction testing confirmed active, viremic infection in 128 people.

Fifty-three percent of the participants said they had not been tested for HCV previously, and 72% of the infections reported during the pilot program had not been recorded in the state's electronic disease surveillance system. These new patients were younger and more likely to be non-Latino whites than patients who had been reported to the public health department.

"The most common risk behavior or exposure reported by participants was injection drug use, reported by 1,033 (82%) of the 1,255 participants," Stockman and colleagues write.

"Among the participants, 825 (66%) reported sharing drug injection equipment, and 531 (42%) reported sharing equipment within 6 months of testing," they continue. Because drug users visiting needle exchange programs still share needles, the authors emphasize that connecting individuals with active infections with medical care is crucial to blunting the spread of disease.

"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," Stockman and colleagues conclude. "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."

Morb Mortal Wkly Rep. 2014;63:309-311. Full text

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