Assessment of the Capacity for Hepatitis C Virus Testing in Arkansas County Health Units *

BACKGROUND:  Hepatitis C is a reportable condition in Arkansas; however, the ability to test for hepatitis C virus (HCV) antibodies or ribonucleic acid (RNA) was not available in Arkansas Department of Health (ADH) local health units (LHUs) before 2014. Recommendations for the screening of persons born 1945 – 1965 (i.e. baby boomers) by the Centers for Disease Control and Prevention (CDC) and the United States Preventive Service Task Force (USPSTF) and anticipated increases in insurance coverage in Arkansas due to the Affordable Care Act and the expansion of Arkansas Medicaid prompted an assessment of the feasibility, strategies, and costs of HCV testing in LHUs.

METHODS:  Data from LHU client visits during July 1, 2012 – June 30, 2013 were examined. Data from the Arkansas Cardiovascular Health Examination Survey (ARCHES), a state-wide, representative, cross-sectional, seroprevalence study of non-institutionalized adult Arkansans, was used to estimate the prevalence of HCV in Arkansas and the number of Arkansans reporting injection drug use (IDU), sex with an IDU, or blood transfusion before 1992. Costs of testing were estimated for screening baby boomers and persons with risk factors for HCV.

RESULTS:  During the one year period, 101,762 individuals received care in LHUs during 232,266 visits. Among LHU clients, 5,655 persons were baby boomers; 86,662 persons were ≥18 years of age and born before 1945 or after 1965. Analysis of ARCHES data demonstrated a 2% prevalence of HCV antibodies and that 12.8% of non-institutionalized, adult Arkansans ever engaged in IDU, had an IDU sex partner, or had a blood transfusion before 1992. With the goal of testing all LHU clients born 1945 – 1965 and persons with at least one risk factor, approximately 16,748 persons would be eligible for screening in a one year time period, and approximately 335 persons would test positive for HCV antibodies. The approximate cost per HCV antibody test would be $16.29, for a total cost of $272,825. Direct costs of confirmatory HCV RNA testing would be $390 per test, for a total cost of $130,650. Assuming 85% of antibody-positive persons develop chronic infection, confirmatory testing would identify 285 persons with chronic HCV at a cost of $1416 per case identified.

CONCLUSIONS:  The addition of HCV testing in Arkansas LHUs aligns with recent CDC and USPSTF recommendations. Testing is feasible given expected increases in the number of LHU clients eligible for Medicaid or other insurance and costs of screening and confirmatory HCV testing.