Development of a Standardized, Laboratory Result–Based Hepatitis C Virus Clearance Cascade for Public Health Jurisdictions

During 2013-2016, an estimated 2.4 million people in the United States were living with hepatitis C virus (HCV) infection.1 With the availability of curative treatment since 2013, the United States has established a goal of eliminating hepatitis C as a public health threat by 2030. 2 HCV clearance cascades (hereinafter, HCV cascades) are an important tool to track progress toward elimination, across jurisdictions and at a national level, and to identify disparities in access to testing and treatment.HCV cascades are a sequence of steps that follow progression from testing and treatment to clearance and subsequent infection and can be used to inform public health interventions to facilitate progression along the cascade.Many HCV cascades are developed in a single or regional health system in which both treatment and laboratory data are available.However, an important goal for health departments is to develop population-level cascades that capture data on HCV infection status for all people living in a jurisdiction who might seek care across various health settings.In the absence of treatment information, which is not always readily available in health department surveillance systems, HCV laboratory results can be used to develop HCV cascades.Here, we describe a standardized, laboratory resultbased HCV cascade developed by the Centers for Disease Control and Prevention (CDC) as a guide for health departments (Figure 1, Supplemental Material). Developing a Standardized, Laboratory Result-Based HCV Clearance Cascade for Public Health JurisdictionsIn 2019, the Tennessee Department of Health (TDH) developed a laboratory result-based HCV continuum of cure. 3 In 2020, CDC adapted the TDH approach to develop program guidance for health departments on how to construct a laboratory result-based HCV cascade (Figure 2).CDC solicited feedback on guidance from 8 health departments (Florida Department of Health, Kentucky Department for Public Health, Louisiana Department of Health, Massachusetts Department of Public Health, Michigan Department of Health and Human Services, New York City Department of Health and Mental Hygiene, North Carolina Department of Health and Human Services, and TDH) and from the Council of State and Territorial Epidemiologists' Hepatitis C Subcommittee.The laboratory result-based HCV cascade consists of 5 steps: ever infected, viral testing, initial infection, cured or cleared, and persistent infection or reinfection.Progression through each step in the HCV cascade is determined based on laboratory test results reported to the health department.Constructing a population-level HCV cascade requires a few minimum essential elements.Health departments must be able to receive, deduplicate, and track person-level longitudinal HCV laboratory test results from multiple health systems, health providers, public health laboratories, and commercial laboratories.Reportable laboratory results should include all reactive HCV antibody, detectable and undetectable HCV RNA, and, when available, detectable and 1170044P HRXXX10.