Injection Drug use and Hepatitis C: Interventions in Behavioral Health Settings

Background: Georgia is experiencing a crisis of injection drug use and hepatitis C virus (HCV) infection. From 2002 to 2014, the statewide drug overdose mortality rate increased, with nearly every county experiencing a significant increase in drug overdose mortality. Especially concerning is the rising HCV infection rate in people younger than 30, many of whom inject drugs. HCV incidence in young people increased over 200% in Georgia from 2006 to 2012. CDC officials have suggested “…Georgia is experiencing an expanding epidemic of heroin use that is driving an increase in injection drug use, putting many more at risk for the spread of HIV and HCV infection.” Methods: Now in its second year, Imagine Hope is a Georgia-wide project that includes 20 agencies (8 methadone clinics, 12 abstinence based agencies) serving substance-using populations. It offers free routine HCV testing and linkage to care. Nearly all individuals served inject drugs. The agencies have implemented a novel combination of embedding routine HCV testing into services; tandem testing for HCV and HIV; linking individuals to HCV care and treatment; and providing access to two support groups. Results: Over 18 months, 6,136 consumers received HCV antibody testing. Of those, 677 (11%) were HCV antibody positive (Ab+), with 83% of them born outside the baby-boomer cohort. To confirm HCV status, clinics conducted RNA tests, completing 464 such tests that yielded 381 (82.1%) confirmed cases of HCV. Currently, the project has linked 102 (36.8%) confirmed HCV+ clients to care and treatment services, with 12 (11.8%) clients experiencing total remission. Conclusions: Among intravenous drug users, HCV prevalence is high, while infection awareness is low. Navigators and support groups enhance linkage. Connecting a population of mostly uninsured behavioral health clients to care is feasible. Providing HCV RNA confirmatory testing in the behavioral health setting greatly enhances the linkage to care process. Key words: hepatitis C, HCV, injection drug use, HCV Rapid Testin