Alaska Sees HCV Reduction, But Need For Greater Test-And Treat Adoption Remains

In a recent Morbidity and Mortality Weekly Report (MMWR), investigators reported that the state of Alaska saw reductions in incidence rates of hepatitis C. “The average annual rate of newly reported chronic hepatitis C (cases per 100,000 adults) during 2016–2023 was 121; the rate decreased a relative 30% from 142 (2016–2019) to 99 (2020–2023).”¹

The investigators noted that most groups saw decreases, but rates were higher overall in males, people aged 18–39 years, people who live in rural areas, and American Indian or Alaska Native persons.¹

“A majority of the cases were among males (66%) and adults aged <40 years (61%). Overall, 25% of cases were reported among women of reproductive age (18–44 years). Median age of newly reported cases was 38 (IQR = 29–54) years in 2016 and 35 (IQR = 30–45) years in 2023,” the authors wrote.¹

Looking at the incidence rate amongst American Indian or Alaska Native persons, the Centers for Disease Control and Prevention (CDC) statistics previously reported these populations have been especially burdened by hepatitis C especially with mortality rates.

What You Need to Know

Alaska saw a 30% relative decline in the rate of newly reported chronic hepatitis C cases between 2016–2019 and 2020–2023. However, males, individuals aged 18–39, rural residents, and American Indian/Alaska Native populations continue to be disproportionately affected.

American Indian/Alaska Native persons remain heavily burdened by hepatitis C, with death rates still well above national targets (9.99 vs. 3.18 per 100,000 in 2021), despite a slight decrease since 2017.

Emphasis is being placed on adopting single-visit, point-of-care testing and immediate treatment initiation—especially critical for underserved populations like those in remote areas or with unstable housing—to reduce loss to follow-up and improve treatment outcomes.

“Compared to the overall population, non-Hispanic American Indian/Alaska Native (AI/AN) persons had a much higher age-adjusted hepatitis C-related death rate in 2021 (3.18 vs. 9.99 per 100,000, respectively). Although the death rate among non-Hispanic AI/AN persons decreased slightly from 10.24 per 100,000 population in the 2017 baseline year, the rate of 9.99 in 2021 remains above the target rate of 8.19.”²

Across the state, a total of 5,352 newly confirmed cases of chronic HCV among adults were reported during 2016–2023.¹

“Rates of newly reported chronic hepatitis C among Alaska adults aged <40 years during the surveillance period were approximately double the national rates reported during 2018 and during 2019–2022,” the authors wrote.¹

Test and Treat

The authors point the need to have a greater adoption of the CDC’s updated guidance to use single-provider visits to obtain blood samples for both steps in HCV testing and facilitate getting people started on therapy. “The point-of-care HCV RNA test, which was approved in June 2024, could help complement existing test-and-treat strategies, such as for populations in remote areas without road access and for those who use injection drugs,” the authors wrote.

In a previous interview with Contagion, Andrew Aronsohn, MD, associate professor of Medicine, University of Chicago Medical Center, discusses this concept of both screening and getting confirmed HCV patients, treatment all in 1 visit.

“These are folks that may be struggling with addiction; these are folks that may have difficulty with transportation or navigating huge health systems, or maybe undomiciled,” Every time you set up another step for them to have to follow-up, you risking losing them to follow-up. There's a lot of data in HIV and even in hep C, that if you put this all into 1 visit and you can work on some education and actually give them medication in hand before they go out the door it is beneficial," Aronsohn said.

Continued Surveillance

The CDC’s hepatitis C screening recommendations continue to be for all adults, pregnant women for each pregnancy, and people with certain risk factors, such as IV drug users. The MMWR authors stress the importance of continued HCV vigilance to help determine groups at risk.

“Hepatitis C surveillance can help monitor health outcomes and identify groups needing tailored testing and treatment interventions aimed toward hepatitis C elimination,” the authors wrote.