State HCV Incidence and Policies Related to HCV Preventive and Treatment Services for Persons Who Inject Drugs - United States, 2015-2016

Abstract

Hepatitis C is associated with more deaths in the United States than 60 other infectious diseases reported to CDC combined. Despite curative hepatitis C virus (HCV) therapies and known preventive measures to interrupt transmission, new HCV infections have increased in recent years (1,2). Injection drug use is the primary risk factor for new HCV infections (2). One potential strategy to decrease the prevalence of HCV is to create and strengthen public health laws and policies aimed specifically at reducing transmission risks among persons who inject drugs. To evaluate factors affecting access to HCV preventive and treatment services, CDC assessed state laws governing access to safe injection equipment and Medicaid policies related to sobriety requirements for approval of HCV treatment for persons who inject drugs. Acute HCV incidence rates were obtained from CDC's National Notifiable Disease Surveillance System (NNDSS). States were categorized based on analysis of laws related to access to clean needles and syringes and Medicaid HCV treatment policies associated with sobriety requirements. In 2015, HCV incidence remained high in the United States, with rates in 17 states exceeding the national average. Three states were determined to have state laws and Medicaid policies capable of comprehensively preventing and treating HCV among persons who inject drugs. Opportunities exist for states to adopt laws and policies that could help increase access to HCV preventive and treatment services reducing the number of persons at risk for HCV transmission and disease.

FIGURE 1

Acute hepatitis C virus infection incidence rate ratios — United States,^† 2015 * The national rate (0.8 per 100,000 population) is the denominator. ^† Seven states have rates at least twice the national average: Indiana, Kentucky, Maine, Massachusetts, New Mexico, Tennessee, and West Virginia. Ten states have rates above the national average (but not twice the national average): Alabama, Montana, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, Utah, Washington, and Wisconsin.

FIGURE 2

Comprehensiveness of state laws pertinent to prevention of hepatitis C virus infection among persons who inject drugs — United States, 2016 * Assessment of whether a state had established certain laws and the presence or absence of five elements in those laws, i.e., 1) authorization of syringe exchange statewide or in selected jurisdictions; 2) exemption of needles or syringes from the definition of drug paraphernalia; 3) decriminalization of possession and distribution of syringes or needles for participants of a legally authorized syringe service program; 4) avoidance of criminal prosecution for possession of drug paraphernalia by disclosing possession of a needle or sharp object to an arresting officer; and 5) allowance for the retail sale of syringes without a prescription to persons who inject drugs.

FIGURE 3

State Medicaid fee-for-service hepatitis C virus treatment policy restrictions — United States, 2016 * Permissive: Medicaid fee-for-service (FFS) did not require a period of sobriety or only required screening and counseling. Other restrictions, including restrictions based on liver disease or specialty provider requirements are not included; Restrictive: Medicaid FFS required a period of sobriety from drugs and/or alcohol; Not available: No information on Medicaid treatment policy available.