Awareness of Infection and Medical Follow-Up Among persons Testing Positive for Hepatitis C Virus — National Health and Nutrition Examination Survey, 2001‒2014

Background: Hepatitis C virus (HCV) infection can remain asymptomatic for years, limiting awareness of infection and making linkage to care and treatment challenging. Methods: The National Health and Nutrition Examination Survey (NHANES) 2001‒2012 conducted a follow-up survey of HCV-infected participants to ask about awareness of their HCV infection prior to notification of NHANES HCV test results and care received after their first positive test. NHANES 2013‒2014 asked all participants aged ≥6 years if a health professional had ever told them that they were infected with HCV, and if so, was medication prescribed to treat their HCV infection prior to participation in NHANES.  Per National Center for Health Statistics guidance, estimates from 2013–2014 were weighted to account for the complex sample design, whereas estimates from 2001–2006 and 2007–2012 were not. Results: Of 22,730 participants tested in NHANES during 2001‒2006, 279 (1.2%) had evidence of past or current HCV infection, of whom 138 (49%) responded in the follow-up interview. During 2007‒2012, 51,340 participants aged ≥6 years were tested, and 595 (1.2%) had evidence of past or current HCV infection, of whom 238 (40%) responded in the follow-up interview. The number (%) of NHANES participants aged ≥6 years who tested positive for HCV-RNA in 2001-2006, 2007-2012 and 2013-2014 was 205 (0.9%), 219 (1.0%) and 67 (0.7%), respectively. In the continuum of care for HCV, proportionately more follow-up survey respondents in 2007‒2012 than in 2001–2006 reported that they were aware of their infection prior to receiving the NHANES report of findings letter (59% vs. 50%), had seen a doctor for HCV infection (55% vs. 41%), were told follow-up was needed (35% vs. 24%), were told about medications for HCV (33% vs. 16%), were told treatment was needed (28% vs. 12%), and were treated (22% vs 7%) (Figure). In NHANES 2013‒2014, 31 (54%) were aware of and 13 (30%) were prescribed medications for their HCV infection. Conclusion: NHANES data indicate that from 2001 through 2014, only 50-60% of those infected with HCV were aware of their infection, but over those years awareness and linkage to care and treatment improved. Figure. HCV awareness and care cascade among NHANES participants — 2001–2006, 2007–2012, and 2013–2014*