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BACKGROUND: Several states, including Wisconsin, have reported an increase in new hepatitis C virus (HCV) infections from 2010 – 2013 among young persons who inject drugs (PWID). Since 2012, the Wisconsin Division of Public Health has supported community-based HCV screening among PWID using rapid HCV antibody tests. How often persons diagnosed with HCV in these settings are linked to medical care for evaluation and treatment is not known.
METHODS: Hepatitis C virus antibody screening was offered to clients of four agencies providing outreach and prevention to PWIDs in Wisconsin during October 2012 – October 2013. All clients with reactive antibody tests were offered confirmatory HCV RNA testing through the Wisconsin State Laboratory of Hygiene. Wisconsin HCV surveillance records were retrospectively reviewed to assess whether persons diagnosed with HCV in an outreach agency received follow-up care. Follow-up care was defined as a positive HCV antibody, HCV nucleic acid or an HCV genotype test result reported by a provider outside of the outreach agency within 12 months from the date of reactive rapid HCV test. Logistic regression was used to determine which demographic and behavioral factors were independently associated with follow-up care.
RESULTS: From October 2012 – October 2013, 1,044 persons with a history of injection drug use were tested with rapid anti-HCV test; 237 (23%) were reactive of whom 175 (74%) were screened for HCV RNA and 122 (70%) had current infection. Forty-one (34%) with confirmed active HCV infection had evidence of subsequent HCV testing in a clinical setting and of these, 11 (9%) received a genotyping test suggestive of evaluation for HCV antiviral therapy. There were no significant associations with follow-up care by sex, age, race or urban residence. Median time from diagnosis in the outreach agency to positive follow-up HCV test was 4 months (range 4 days – 12 months). Individuals were most likely to receive follow-up in adult medicine, internal medicine or family practice clinics (17, 41%). Eleven (27%) received follow-up care from gastroenterology or hepatology specialists, 9 (22%) in a Wisconsin correctional facility and 4 (10%) in other specialties.
CONCLUSIONS: Rapid detection of HCV antibody followed by confirmatory testing can effectively identify HCV in PWID in Wisconsin. However, fewer than half (34%) of individuals with current HCV infection received follow-up care and 9% were evaluated for therapy. Greater access to care is needed. Increasing options for HCV treatment in primary care and correctional settings may have an impact on treating HCV in this population.