HCV Testing and Linkage for People who Inject Drugs

Author: Ninburg M, Thiede H, Hannon B, Amato C

Theme: Epidemiology & Public Health Research Year: 2015

The Seattle area HepTLC project (2012-14) was a CDC-funded collaborative effort between Public Health – Seattle & King County (PHSKC) and several medical centers and agencies, including the Hepatitis Education Project (HEP), to test persons who inject drugs (PWID) for HCV infection and link them to care and prevention services.

Testing was done at two syringe exchange sites and one methadone clinic. We developed written procedures for each testing site and produced site-specific posters with HCV testing information for clients. Antibody testing was done using rapid testing on finger stick blood, so clients could receive results immediately. Blood draws were performed for confirmatory RNA testing.

859 persons were tested, of whom 427 (50%) were HCV antibody positive and 149 (35%) received a confirmatory RNA test. A total of 108 (72%) were RNA positive, 84 (78%) were referred to care and 97 (90%) were reported to surveillance.

Each testing site used a different HCV testing activities model that was developed to meet respective needs and systems. Each model had advantages and disadvantages. Lessons learned included:
• Providing incentives proved effective in getting more people tested and their test results delivered. One drawback, however, included testing persons who had already been diagnosed with HCV infection.
• Having a skilled phlebotomist available on-site during testing sessions helped ensure that a high proportion of antibody positive clients received confirmatory testing.
• The proportion of newly diagnosed cases (defined as not previously reported to surveillance) varied greatly by site and can serve as one indicator for where to focus testing efforts.
• Linkage to care proved challenging at all sites, but was most successful at the methadone clinic. This suggests potential for expansion of linkage efforts in this setting.
• It was challenging to manage the entire project with the limited funding provided through the grant.

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