Estimated hepatitis C prevalence and key population sizes in San Francisco: A foundation for elimination

Abstract

BackgroundInitiated in 2016, End Hep C SF is a comprehensive initiative to eliminate hepatitis C (HCV) infection in San Francisco. The introduction of direct-acting antivirals to treat and cure HCV provides an opportunity for elimination. To properly measure progress, an estimate of baseline HCV prevalence, and of the number of people in various subpopulations with active HCV infection, is required to target and measure the impact of interventions. Our analysis was designed to incorporate multiple relevant data sources and estimate HCV burden for the San Francisco population as a whole, including specific key populations at higher risk of infection.MethodsOur estimates are based on triangulation of data found in case registries, medical records, observational studies, and published literature from 2010 through 2017. We examined subpopulations based on sex, age and/or HCV risk group. When multiple sources of data were available for subpopulation estimates, we calculated a weighted average using inverse variance weighting. Credible ranges (CRs) were derived from 95% confidence intervals of population size and prevalence estimates.ResultsWe estimate that 21,758 residents of San Francisco are HCV seropositive (CR: 10,274–42,067), representing an overall seroprevalence of 2.5% (CR: 1.2%– 4.9%). Of these, 16,408 are estimated to be viremic (CR: 6,505–37,407), though this estimate includes treated cases; up to 12,257 of these (CR: 2,354–33,256) are people who are untreated and infectious. People who injected drugs in the last year represent 67.9% of viremic HCV infections.ConclusionsWe estimated approximately 7,400 (51%) more HCV seropositive cases than are included in San Francisco’s HCV surveillance case registry. Our estimate provides a useful baseline against which the impact of End Hep C SF can be measured.

Seroprevalence of markers of hepatitis C virus exposure and associated factors in adults aged 18-39 years in the Arctic Russian city of Arkhangelsk: a cross-sectional study

“…A study among blood donors in China did not find gender differences in the prevalence of anti-HCV antibody [22]. However, the prevalence of HCV infection among men was about twice as high as among women in the USA and Iran [23][24][25]. In our study, the prevalence of anti-HCV antibody was higher among men compared to women (6.4% vs. 4.3%).…”

Cost‐effectiveness of scaling‐up HCV prevention and treatment in the United States for people who inject drugs

“…In 2016, SF initiated an aggressive campaign to eliminate HCV that promotes HCV treatment for at‐risk groups, including PWID. Treatment rates are increasing, but specific rates for PWID are not available .…”

Treatment cascade for hepatitis C virus in young adult people who inject drugs in San Francisco: Low number treated

“…Our study provides preliminary evidence of successful HCV treatment among young adults who initiate treatment, but also identifies missed opportunities for linking young adult PWID to therapy. To put our results into context, of an estimated 16,393 people with HCV infection in San Francisco, 11,147 (68%) are PWID; an estimated 847 are under the age of 30 years (Facente et al, 2018). Nationally, young adult PWID are the fastest growing population infected with HCV (Zibbell et al, 2018).…”