Though the largest wave of new hepatitis C infections appears to be among younger people in rural areas, there are still more chronic cases in urban areas. A recent study in Philadelphia tested new strategies to get more poor and uninsured patients tested and into treatment. Ramping up efforts at five community health centers did prove successful, but it also showed that fighting hepatitis C will be challenging.

The health centers, all run by the nonprofit Public Health Management Corp., provide primary-care services to low-income groups who may be hard to reach and at high risk for hepatitis C, such as people who are homeless or infected with HIV. From October 2012 through July 2014, they aimed to test every patient who was considered at risk, including anyone who was homeless, injected illicit drugs, or was born between 1945 and 1965.

The clinics made several changes to do that: designating medical assistants to guide patients through the testing process; using the same specimen for initial antibody testing and confirmation tests; eliminating the need for a second visit; making tests free for uninsured people; adding the hepatitis C test to everyone eligible for an HIV test, which raised the number tested; placing prompts in patients' electronic medical records; and, most important, hiring a "linkage-to-care coordinator" who did intensive follow-up, including tracking down homeless people who missed appointments, and escorting others to office visits.

Nearly 9 percent of those tested were confirmed to have chronic hepatitis C, compared to the general population estimate of less than 1 percent. Of those with chronic infection, 90 percent were told of their status, 78 percent were referred to a specialist, and 62 percent went to that specialist for care. These were all higher than previous observations had found in Philadelphia, the authors wrote in the May 8 issue of the Morbidity and Mortality Weekly Report, a federal journal of public-health case studies.

 The study was designed to be carried out in a network of big-city health clinics. It did not look at the challenges of providing treatment in rural areas, where there may not be many health centers to begin with.

- Don Sapatkin