BACKGROUND: Approximately 2.5–4.7 million persons are living with chronic hepatitis C virus (HCV) in the United States. Surveillance data from Appalachian states during 2006–2012 revealed a 364% increase in acute HCV infections among persons aged ≤30 years. We sought to more fully understand HCV infection prevalence and risk factors in Eastern Tennessee.
METHODS: During June–October 2016, routine, opt-out HCV testing was offered to patients in sexually transmitted diseases and family planning clinics in 2 health departments in Eastern Tennessee (Knox and Hamilton Counties), and targeted testing was offered in Sullivan County. Standard HCV testing procedures (antibody testing with reflex qualitative polymerase chain reaction [PCR]) were followed. Demographic and risk factor information was collected. We performed multivariate logistic regression to estimate odds ratios (ORs) for associations between risk factors and past or present HCV infection.
RESULTS: A total of 4,753 persons were tested for HCV. Of these, 397 (8.4%) were HCV-antibody positive (Ab+) and, of those, 294 (74.1%) were PCR positive. The median age of Ab+ persons was 34 years (range: 14–71 years). Significantly more Ab+ persons were male (204/397 [51.4%]) than were Ab- persons (1,688/4,356 [38.8%]; P <0.001); and compared to all other race/ethnicities, more Ab+ persons were non-Hispanic white (339/397 [85.4%]) than were Ab- persons (1,952/4,356 [44.8%]; P <0.001). Among Ab+ persons, 43.1% (171/397) were females of reproductive age (11–50 years), and of those, 5 were pregnant (2.9%). The following exposures were significantly associated with past or present HCV infection: history of both intranasal and injection drug use (IDU) versus no drug use (OR: 35.4, CI: 24.1–51.9); history of IDU alone versus no drug use (OR: 52.7; CI: 25.2–109.9); history of intranasal drug use alone versus no drug use (OR: 2.6, CI: 1.7–3.9); and history of incarceration versus no incarceration (OR: 2.7; CI: 1.9–3.8 ).
CONCLUSIONS: Testing demonstrated a past or present HCV infection prevalence of 8.4% among select clinic populations in Eastern Tennessee. A greater proportion of Ab+ persons were male and non-Hispanic white than antibody-negative persons. Forty‑three percent of Ab+ persons identified were females of reproductive age. A history of intranasal drug use, IDU, and incarceration were the predominant risk factors identified. This analysis is the first to quantify HCV burden in Eastern Tennessee among health department patients, and highlights the need for targeted interventions among high-risk groups (IDU) and vulnerable populations (e.g., females of reproductive age).