The needle exchange turned out to be the best place to test for hepatitis C

**Georgia has a high prevalence of hepatitis C and a high prevalence of
injection drug use**, and launched a **hepatitis C elimination programme in
2015.**

It also had something in place since 2006: **needle and syringe programmes
offering HCV antibody testing** to people who inject drugs.

What happened after 2015

Why the site matters more than the test

Hepatitis C is concentrated among people who inject drugs, and that is the
group least likely to be reached by a clinic-based screening programme —
through cost, through stigma, through prior experience of how they are treated
in health settings, and through having other priorities.

A needle and syringe programme has already solved all of that. People come,
voluntarily, repeatedly, for a service they want, from staff who do not judge
them. Adding a test to that visit costs a fraction of what building a new
outreach service would, and reaches the people the new service would be trying
to find.

Which is the report's conclusion: **hepatitis C testing at needle and syringe
programmes is an effective strategy for identifying people with HCV
infection.**

The pattern is the same one behind WISEWOMAN attaching cardiovascular screening
to a cancer programme, and behind Georgia's own numbers here: **the expensive
part of a screening programme is finding the people, and sometimes somebody has
already found them.**

Why "doubled" rather than "fivefold"

Tests rose fivefold and positives doubled — so the positivity rate fell. That
is the expected shape when a programme expands beyond the people already known
to be at highest risk, and it is a sign of reach rather than of waste.

The programme in Georgia might serve as a model for other countries.

Source: Centers for Disease Control and Prevention, MMWR.