Document Type

Policy Brief

Publication Date



rural, HIV, hepatitis C, public health, capacity, testing, treatment, substance use, MRHRC


HIV and hepatitis C (HCV) are major public health concerns in the United States and are a focus of significant federal health policy attention. Rural counties may be potentially vulnerable to an HIV or HCV outbreak among persons who inject drugs due to greater prevalence of high-risk injection practices as well as limited public health capacity to prevent, prepare for, and respond to an HIV or HCV outbreak. This study identified states potentially at risk for an HIV or HCV outbreak and used data from the 2016 Association of State and Territorial Health Officials (ASTHO) Profile Survey, 2016 National Association of City and County Health Officials (NACCHO) National Profile of Local Health Departments (LHD), and 2016-2017 Area Health Resource File to examine rural-urban differences in (1) state-level infectious disease surveillance, prevention activities, and collaboration with stakeholders; (2) LHD-level activities related to preventing, preparing for, and responding to an HIV or HCV outbreak; and (3) socioeconomic characteristics and health resources of counties at potential risk for an HIV or HCV outbreak. LHDs located in rural counties in at-risk states were less likely to offer services that may help address an HIV or HCV outbreak, including HIV testing, HIV services, and infectious disease surveillance. Rural LHDs were also less likely to report a history of partnerships with community-based organizations that may be important resources during an outbreak, including community health centers and faith-based organizations.


For more information, please contact Dr. Erika Ziller,

This study was funded by a cooperative agreement between the US Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services (CA#U1CRH03716) and the University of Southern Maine. The findings and conclusions expressed in this report are those of the authors and do not necessarily represent the official position of the US Federal Office of Rural Health Policy.

Funding Organization

Federal Office of Rural Health Policy

Grant Number




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