Reduce reported rate of new hepatitis C 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, a proxy for persons who inject drugs (PWID), has increased steadily since 2013 to a peak of 2.9 cases per 100,000 population in 2020. The 2022 rate was 2.7 cases per 100,000 population, above the 2022 target rate of 1.8 cases per 100,000 population, and 2022 marks the second year that the rate has decreased after 8 consecutive years of increase. Changes in drug use practices and other prevention initiatives, such as syringe services programs and medication for opioid use disorder programs, might be contributing to these observed decreases.^2,3 During 2020–2022, there were major disruptions in access to medical care, testing, and routine viral hepatitis public health activities due to the COVID-19 pandemic; therefore, 2020–2022 data should be interpreted with caution.

Reduction needed to meet 2025 goal:
A 37% reduction from the 2022 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 PWID by developing and delivering tailored hepatitis C education materials and offering testing in places that PWID go.
• Supporting efforts to improve access to routine hepatitis C testing and increase access to curative treatment among PWID with hepatitis C.
• Supporting continuing medical education and developing partnerships among providers to improve confidence and comfort when working with stigmatized populations.
• Building capacity within jurisdictions to collect and use a core set of surveillance data as well as prioritize new data collection initiatives that will help pinpoint where hepatitis C virus (HCV) infection 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 treatment programs.
• 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)

Numerator:
Number of new (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:
NNDSS is a nationwide collaboration that enables all levels of public health to share notifiable disease-related health information.¹ 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 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 except Alaska. 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.¹

Goal setting:
The 2025 goal of 1.7 cases per 100,000 population is consistent with CDC’s Division of Viral Hepatitis 2025 Strategic Plan and the US Department of Health and Human Services’ 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.^1,4 This estimate has not been revised to reflect the 2020 acute hepatitis C case definition change. Additionally, rates of reported cases might vary over time based on changes in public and provider awareness, laboratory and diagnostic techniques, and the case definition for the condition.