Transmission Clusters of Hepatitis C Virus among Public Health and Correctional Settings in Wisconsin, 2016-2017

Ending the hepatitis C virus (HCV) epidemic requires stopping transmission among networks of people who inject drugs (PWID). Identification of transmission networks through the application of genomic epidemiology may inform community response models that can quickly interrupt transmission. We retrospectively identified HCV RNA-positive specimens corresponding to 459 individuals tested in public health settings, including correctional facilities and syringe service programs, in Wisconsin from 2016-2017. Next-generation sequencing of HCV was conducted and analyzed for phylogenetic linkage using the CDC’s Global Hepatitis Outbreak Surveillance Technology platform. Transmission network analysis showed that 126 individuals were linked across 42 clusters (range: 2-11 individuals per cluster). Phylogenetic clustering was higher in rural communities and associated with female gender and younger age among rural residents. These data highlight that the increasing rurality of opioid injection use and HCV transmission among young PWID could be better supported by the expansion of molecular-based surveillance strategies to reduce transmission. Article Summary Line Integrating existing public health surveillance and molecular analyses with Global Hepatitis Outbreak Surveillance Technology allows for the identification and characterization of growing HCV transmission clusters among key populations in Wisconsin. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by grants from the National Institute on Drug Abuse at the National Institutes of Health: UG3 DA044826 (Westergaard and Seal), U24 DA044801 (Allen), and R25 DA037190 (Hochstatter). Karli Hochstatter is also funded by a T32 DA037801 (NIDA). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the University of Wisconsin Health Sciences Institutional Review Board and the Massachusetts General Hospital Institutional Review Board. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data that support these findings will be available upon request.