Facility-Reported Hepatitis C Virus Surveillance in United States Outpatient Dialysis Facilities, 2024

Background: In hemodialysis, blood contamination of the shared treatment area and equipment is common and hepatitis C virus (HCV) transmission is a risk. Between 2008—2019, 22 HCV outbreaks in U.S. hemodialysis facilities, with 104 outbreak-associated infections, were reported to the CDC. To prevent outbreaks, detect HCV transmission early, and ensure timely referral for treatment, HCV surveillance in the HD setting is critical. Adherence to recommended IPC practices, including testing for HCV on admission and semi-annually, combined with monthly alanine transferase (i.e., liver function test), is essential to detecting HCV transmission in dialysis facilities. We describe facility-reported HCV prevalence and screening practices in U.S. outpatient dialysis facilities in 2024. Methods: Dialysis facilities complete the 2024 National Healthcare Safety Network Outpatient Dialysis Practices Survey on enrollment and annually thereafter. Data from the survey were analyzed, including descriptive statistics, to assess facilities’ HCV screening practices and HCV antibody (anti-HCV) prevalence among in-center patients. Results: A total of 6,975 (99.9%) facilities completed required responses to the 2024 Practices Survey, comprising 435,498 in-center patients. Fifty-six percent (n=3,890) of facilities had ≥ 1 anti-HCV positive patient, with a median of 1 anti-HCV positive patient per facility (interquartile range 1-3). Ninety-four percent (n=6,580) of the facilities reported screening in-center patients for anti-HCV on admission; 37.3% (n=2,452) screened twice semi-annually. Among 13,798 anti-HCV positive patients reported in February 2024, 12,900 (93.5%) were anti-HCV positive on admission; 265 (1.9%) patients seroconverted from anti-HCV negative to positive in the prior 12 months. Conclusion: HCV transmission in dialysis facilities remains a risk to hemodialysis patients; the full extent of this risk is underappreciated given the low adherence to recommended semi-annual HCV screening that could detect additional HCV seroconversion events. Moreover, failure to detect HCV seroconversions can lead to missed opportunities to investigate and halt transmission, and promptly refer patients for HCV treatment. Funding: Other U.S. Government Support