Reduce reported rate of new hepatitis C virus infections among persons who inject drugs by 25% or more

Summary of Findings

The rate of new hepatitis C cases reported to CDC among persons aged 18–40 years has increased steadily each year since 2013 to 2.9 cases per 100,000 population in 2020, above the 2020 target rate of 2.0 per 100,000 population. Injection drug use is the most common risk reported for persons with new hepatitis C virus infection, and increases in hepatitis C incidence, particularly among persons aged 18–40 years, are temporally associated with increases in this risk factor (1). During 2020, there were major disruptions in access to medical care, testing, and routine viral hepatitis public health activities due to the COVID-19 pandemic; therefore, 2020 data should be interpreted with caution.

Reduction needed to meet 2025 goal

A 41% reduction from the 2020 rate of reported new hepatitis C cases is needed to meet the 2025 goal of 1.7 cases per 100,000 population.

This reduction can best be achieved by:

• Encouraging testing among people who inject drugs (PWID) by developing and delivering tailored hepatitis C education materials and meeting people where they are by offering testing in places that PWID go.
• Supporting efforts to improve access to routine hepatitis C testing among and increasing access to appropriate treatment that can cure PWID with hepatitis C.
• Supporting continuing medical education and developing partnerships to improve confidence and comfort when working with stigmatized populations.
• Building capacity within jurisdictions to make it easier for them to collect and use a core set of surveillance data as well as prioritize new data collection initiatives (molecular, computational, informational) that will help pinpoint where HCV is occurring, understand transmission networks, and enhance what is learned from outbreak investigations among PWID.
• Increasing access to syringe services programs and linkage to testing and medication-assisted treatment programs by implementing comprehensive community-level programs for PWID.
• Increasing availability, access and use of hepatitis C prevention services in settings that serve PWID by building and leveraging partnerships that promote proven prevention strategies.
• Conducting research focused on improving strategies to decrease hepatitis C incidence among PWID.

Technical Notes

Data Sources:
CDC, National Notifiable Diseases Surveillance System (NNDSS) and CDC/National Center for Health Statistics/US Census Bureau, Bridged-race Population Estimates

Numerator:
Number of acute HCV infections reported annually among persons aged 18–40 years

Denominator:
Total population of persons aged 18–40 years in reporting jurisdictions

Indicator Notes:
(1) NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable-disease-related health information. Surveillance for viral hepatitis through NNDSS is based on case definitions developed and approved by the Council of State and Territorial Epidemiologists (CSTE) and CDC. Reported cases of acute viral hepatitis C are required to meet specific clinical and laboratory criteria. Only laboratory-confirmed cases of acute viral hepatitis are presented in this report. Acute hepatitis C is reportable in all jurisdictions. Health care providers, hospitals, and/or laboratories report cases to the local or state health department, and states voluntarily submit reports or notify CDC of newly diagnosed cases of hepatitis C that meet the CSTE/CDC surveillance case definition. Case rates per 100,000 population are calculated based on the projected resident population of the United States as of July 1 during each data-collection year.

Goal Setting:
The 2025 goal of 1.7 per 100,000 population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and HHS’s 2021-2025 Viral Hepatitis National Strategic Plan. Annual targets assume a constant (linear) rate of change from the observed baseline (2017 data year) to the 2025 goal (2023 data year).

Limitations:
Viral hepatitis is largely underreported in NNDSS. Based on a simple, probabilistic model for estimating the proportion of patients who were symptomatic, received testing, and were reported to health officials in each year, the actual number of acute hepatitis C cases is estimated to be 13.9 times the number reported to CDC. (1–2) This estimate has not been revised to reflect the 2020 acute hepatitis C case definition change. Additionally, rates of reported cases may vary over time based on changes in public and provider awareness, laboratory and diagnostic techniques, and the definition of the condition.