1. Hepatitis C Rapid Antibody Testing Among At-Risk Populations, Arizona, 2014 Felicia McLean Public Health Associate Office for State, Tribal, Local and Territorial Support Centers for Disease Control and Prevention Public Health Associate Program's Summer Training June 3 2015 Centers for Disease Control and Prevention Office for State, Tribal, Local and Territorial Support

2. 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

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

4. Estimates of People with Hepatitis C in Arizona 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 residentshttp://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf Number People with Reactive anti-HCV Antibody

5. 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

6. 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

7. 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

8. 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

9. HCV Rapid Antibody Testing Project

11. * Target population: Injection drug users (IDU)

12. Quarterly Reporting Form

14. 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

15. HCV Rapid Testing and Results by Gender

16. Reactivity by Age Group 18-24: 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

17. Race Distribution of those Tested, N = 215 Race Distribution of those Reactive, n = 43 HCV Rapid Testing and Results by Race

18. *Not mutually exclusive or patients may have multiple risk factors

19. Risk Factor: Injection Drug Use

20. Risk Factor: Intranasal Drug Use

21. Risk Factor: Incarceration Incarceration Among Tested Population, N = 215 Incarceration Among Reactive Population, n = 43

22. 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

23. 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

24. Acknowledgments  ADHS  Clarisse Tsang  Mohammed Khan  HCV Rapid Testing Sites  TERROS  Pascua Yaqui Tribe  Southwest Center for HIV and AIDS

25. For more information, please contact CDC’s Office for State, Tribal, Local and Territorial Support 4770 Buford Highway NE, Mailstop E-70, Atlanta, GA 30341 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 E-mail: OSTLTSfeedback@cdc.govWeb: http://www.cdc.gov/stltpublichealthOSTLTSfeedback@cdc.govhttp://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?