title: Efforts at the Frontlines: Implementing a Hepatitis C Testing and Linkage-to-Care Program at the Local Public Health Level.
abstract: The national Viral Hepatitis Action Plan recommends strengthening partnerships among health departments, community-based organizations, and health-care providers for hepatitis services. We implemented a hepatitis C virus (HCV) testing and linkage-to-care program through a local health department using similar strategies reported for HIV care.
  
  
  
  The Durham County Department of Public Health received federal funding to conduct HCV testing and linkage to care in Durham, North Carolina. HCV antibody testing with reflex RNA was offered through a sexually transmitted disease clinic, a county jail, community testing sites (including a residential substance abuse recovery program), and a homeless clinic. People with evidence of HCV infection were linked to care through an HCV bridge counselor who provided education, incentives, and transportation, and scheduled appointments with HCV specialists at nearby academic centers and on-site clinics.
  
  
  
  From December 2012 through February 2014, we conducted 2,004 HCV tests, of which 326 (16.3%) were HCV antibody positive and 241 (12.0%) had detectable HCV RNA. Among the 241 people with HCV infection, 178 (73.9%) were men, and 133 (55.2%) were born between 1945 and 1965. Of 241 people with chronic HCV infection, 150 (62.2%) reported ever injecting drugs, eight (2.5%) were coinfected with HIV, and 123 (51.0%) were linked to care.
  
  
  
  At the local public health level, HCV testing and linkage to care can be facilitated with additional funding and by leveraging existing programs and provider networks to deliver a coordinated system of care.
authors.affiliation: Durham County Department of Public Health, Durham, NC; University of North Carolina at Chapel Hill, Department of Medicine, Institute for Global Health and Infectious Diseases, Chapel Hill, NC.
authors.forename: Arlene C
authors.initials: AC
authors.lastname: Seña
authors.affiliation: University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, Chapel Hill, NC.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Willis
authors.affiliation: Durham County Department of Public Health, Durham, NC.
authors.forename: Alison
authors.initials: A
authors.lastname: Hilton
authors.affiliation: Durham County Department of Public Health, Durham, NC.
authors.forename: Alexandria
authors.initials: A
authors.lastname: Anderson
authors.affiliation: University of North Carolina at Chapel Hill, Department of Medicine, Institute for Global Health and Infectious Diseases, Chapel Hill, NC.
authors.forename: David A
authors.initials: DA
authors.lastname: Wohl
authors.affiliation: University of North Carolina at Chapel Hill, Department of Medicine, Institute for Global Health and Infectious Diseases, Chapel Hill, NC.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Hurt
authors.affiliation: Duke University School of Medicine, Division of Gastroenterology and Duke Clinical Research Institute, Durham NC.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D006293:Health Promotion; D006297:Health Services Accessibility / Q000458:organization & administration*; D016174:Hepacivirus / Q000302:isolation & purification; D006526:Hepatitis C / Q000175:diagnosis*; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D015995:Prevalence; D011330:Prisons; D011635:Public Health Administration
chemical_list: D018937:Hepatitis C Antibodies