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HCV Care in Nontraditional Settings

CE / CME

HCV Care in Nontraditional Settings: A Focus on Vulnerable Populations

Social Workers: 1.00 ASWB ACE CE Credit

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: June 02, 2025

Expiration: June 01, 2026

Oluwaseun Falade-Nwulia
Oluwaseun Falade-Nwulia, MBBS, MPH
CME/CE Information

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WHO: Global Call for HCV Elimination

With the advent of oral direct-acting antiretrovirals (DAAs) and increased availability of harm reduction interventions proven to prevent HCV infection, WHO put out a call in 2016 for elimination of the disease by 2030, as it is a major global public health threat.1

Achievement of this goal is incredibly important. It would avert 1.5 million deaths from HCV infection.2

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Viral Hepatitis National Strategic Plan: Roadmap to Elimination 2021-2025

In the United States, the Viral Hepatitis National Strategic Plan provides a framework for working towards elimination of HCV from 2021 through 2025.

In particular, I would like to highlight the goals related to reducing HCV-related health disparities, as these inequities continue to be among the biggest challenges to eliminating HCV in the United States.

The last goal, addressing social determinants of health, is of particular importance because populations that are more likely to acquire and be living with HCV are also more likely to have multiple negative social determinants of health.3,4

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CDC Viral Hepatitis National Progress Report

As we consider where we are with regards to achieving the WHO hepatitis C elimination goals, the most recent data suggest that we may be on track for meeting some of these goals in 2025.

Specifically, it is very exciting that we achieved the goal of reducing the reported rate of HCV-related deaths by ≥20% in 2022.5

Unfortunately, instead of a decrease in new HCV infections, as of 2022, the US has experienced an increase in new HCV infections, both overall and among people who inject drugs.

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CDC HCV Surveillance Report 2022: Reported Cases and Estimated Infections of Acute HCV

There is, however, some good news from the 2022 CDC HCV Surveillance Report.

From 2015 to 2021, we had a steady increase in the number of acute HCV cases. However, in 2022, for the first time, the US experienced a small decline in the number of acute cases.5

These are very exciting data, but this decline was not uniform across all populations. Declines in HCV incidence were driven largely by declines in urban areas, with many rural areas actually seeing increases in number of acute HCV cases. This highlights the urgent need to reach these underserved communities.6

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CDC HCV Surveillance Report 2022: Documented Risk Behaviors or Exposures in HCV Acute Cases

It is important to understand what risk behaviors or exposures are most commonly associated with HCV infection. To this end, the CDC collected data on certain behaviors reported by people diagnosed with acute HCV infections.

Most individuals did not report data on risk behaviors. However, if we focus on those who did report risk behaviors, it is clear that injection drug use is the most prevalent risk factor identified by people with acute HCV infections.5

The next most common risk behaviors or exposure sources are sex with multiple partners and surgical procedures.5

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CDC 2022: HCV Cases by Sex and Age

In terms of the number of HCV cases in the United States by sex and age, there is a bimodal distribution of HCV by age, with a really high prevalence of HCV infection in people between the ages of 20-40 and between the ages of 55 to approximately 75. This older group is referred to as the birth cohort.5

Although we have more HCV cases identified among men, both men and women demonstrate a similar bimodal distribution of HCV cases according to age.5

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CDC 2021: HCV Infections by Racial and Ethnic Groups and Other Vulnerable Populations

The CDC data suggest that there is a current HCV viremia prevalence of approximately 1% in the domiciled United States population. However, the prevalence of HCV varies across different population groups.7

Among individuals identified as Black and non-Hispanic, the prevalence of HCV infection is 1.8%, which is higher than the 1% observed in the general population. In addition, the incidence of acute HCV infection in Black, non-Hispanic Americans increased to 1.4 cases per 100,000 individuals in 2021, from 0.3 cases per 100,000 individuals in 2015. This is an increase in acute infections of greater than 350%.7

Although the percent increase in HCV infections is greatest among Black, non-Hispanic individuals, there were increases in HCV incidence across all racial or ethnic groups when comparing 2021 with 2015 data. American Indian or Alaskan Native individuals experienced the second largest increase (200%), although Hispanic individuals and White, non-Hispanic individuals demonstrated similar percentage increases (approximately 50% to 80%, respectively).7

Data also suggest a higher prevalence of HCV infections among people who are experiencing homelessness or incarceration, with 10.8% among people without homes and 10.7% among people who have been incarcerated. This is approximately 10 times the rate seen in the general population in the United States.7

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