Estimating Hepatitis C Virus Prevalence in US States and the District of Columbia, 2017-2020

Background State-level estimates of hepatitis C virus (HCV) prevalence are needed to guide resource allocation and to provide a baseline against which to measure progress toward elimination goals. Population prevalence is not directly observable, requiring estimation from indirect data sources. Methods We adapted a Bayesian spatial integrated abundance model to estimate state-level HCV prevalence during 2017-2020 across 48 states and the District of Columbia. The model integrated six HCV-related outcomes: acute and chronic surveillance cases, HCV-related deaths, observations of HCV in [MarketScan] administrative claims data, diagnoses of HCV in Medicaid recipients, and treatment with direct-acting antivirals in Medicaid recipients. Estimates were anchored to a national prevalence estimate, and the model accounted for data source-specific selection, heterogeneity in HCV risk factors across states, and geospatial correlation. Results Estimated average prevalence was 1.32% (95% credible interval [CrI]: 0.94%-1.80%), corresponding to 3.33 million (95% CrI: 2.37-4.65 million) adults with HCV infection across 48 states and DC. State estimates ranged from 0.74% in North Dakota to 2.22% in Oklahoma (median state-specific prevalence, 1.27%), with higher prevalence concentrated in South Central states, Appalachia, and the West, and the lower prevalence in the upper Midwest, Southeast, and New England. Ten states accounted for 56% of estimated infections. Estimates were stable in sensitivity analyses (most differences <1 percentage point). Conclusions These estimates quantify state-level HCV burden prior to the 2021 federal expansion of HCV surveillance funding, providing a baseline for monitoring elimination progress. Geographic variation indicates that resource needs will differ by jurisdiction.