Post on 22-Dec-2015
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
ntibo
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?