Hepatitis C Virus ¨C Reduce Rate Among PWID

Incidence rate* of reported new hepatitis C cases among persons aged 18‒40 years^† and annual targets for the United States by year

Source: CDC, National Notifiable Diseases Surveillance System.1
^*Rate per 100,000 population.
^†Persons aged 18–40 years were used as a proxy for persons who inject drugs.

Summary of findings

Among persons aged 18–40 years, a proxy for persons who inject drugs (PWID), the rate of new hepatitis C cases reported to CDC steadily increased from 2013–2020 (from 1.6 to 2.9 cases per 100,000 population, respectively) and decreased from 2021–2023 (from 2.8 to 2.6 per 100,000 population, respectively). The 2023 rate was 2.6 cases per 100,000 population, above the annual target rate of 1.7. Changes in drug use practices (for example, shifts from injection to inhalation) and other prevention initiatives, such as syringe services programs and treatment for substance use disorders, might be contributing to these observed decreases.23

This reduction can best be achieved by:

• Building and harnessing partnerships that amplify the use of effective prevention, testing, and treatment strategies in persons and settings with higher rates of hepatitis C virus (HCV) transmission.
• Building capacity within jurisdictions to collect and analyze surveillance data to identify where HCV infection is occurring, understand transmission networks, and enhance what is learned from outbreak investigations among PWID.
• Developing trainings, technical assistance, and clinical decision support tools for primary care and other health care providers to support and increase implementation of hepatitis C screening, testing, and treatment.
• Increasing access to timely curative treatment by lowering costs, eliminating additional barriers (for example, prior authorization requirements), improving navigation to care, and integrating treatment into routine primary care.
• Increasing access to harm reduction services, such as substance use disorder treatment (for example, medication-assisted treatment) programs, for PWID.
• Promoting and implementing universal hepatitis C screening for all adults at least once in their lifetime and for every pregnant woman during each pregnancy.
• Promoting and implementing more frequent or periodic testing for persons with recognized exposures (such as use of injection drugs) as long as the risk persists and in settings where people receive care.
• Promoting and implementing testing of all infants and children perinatally exposed to hepatitis C.
• Supporting continuing medical education and developing partnerships with service providers to improve confidence and comfort when working with people with HCV infection.
• Using digital technology and telemedicine models to expand access to specialty health care providers.

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.. 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 . 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.14 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.