Hepatitis C and HIV outbreak preparedness planning in Allegheny County: a health services assessment survey

Background: The United States is experiencing a syndemic of hepatitis C, HIV, and opioid overdose. As a result, incidences of hepatitis C and HIV are rising among people who inject drugs (PWID). In response to the rapid transmission of hepatitis C and HIV among PWID, the Allegheny County Health Department (ACHD) conducts an annual survey of facilities that work with clients at high risk of experiencing these outcomes to inform outbreak preparedness planning. Methods: The ACHD contacted 73 facilities that provide services to county residents for the 2023 survey. The sample included substance use treatment clinics, HIV programs, homeless service providers, Federally Qualified Health Centers (FQHC), correctional facilities, and syringe service providers. Forty-eight (66%) facilities responded to the survey that assessed the availability of prevention, testing, and treatment services. Results: The 2023 survey found that many facilities provide linkage to hepatitis C and HIV testing and treatment. Of the responding facilities, 79% (n=38) provided access to hepatitis C antibody testing, 71% (n=34) to hepatitis C RNA testing, and 85% (n=41) to HIV testing. Of the 42 facilities that provided information on hepatitis C treatment services, 81% (n=34) provided clients access to treatment. Many facilities worked with partner agencies that visit periodically to provide services. Partner agencies most commonly visit monthly, indicating that clients have limited access to testing and treatment services. Facilities most frequently cited “lack of staff training," “lack of supplies," and “concerns about cost/billing” as barriers to providing onsite services. Conclusion and Public Health Significance: The 2023 facility survey provides insight into hepatitis C and HIV services available in Allegheny County. Additionally, the survey identified barriers to providing services that can help guide future interventions. Hepatitis C and HIV remain major public health concerns in Allegheny County, and the survey informs the department’s planning effort to detect and mitigate infectious disease outbreaks among populations at high risk of infection.