A 2017 update from the Kentucky Department for Public Health is reporting that the Appalachian state has the highest rate of new hepatitis C virus (HCV) infections in the United States, according to Kentucky.com.

Released in March, the update shows that 1,089 new hepatitis C cases were reported in Kentucky from 2008 to 2015. While U.S. Centers for Disease Control and Prevention (CDC) data indicate that other states may have more total HCV cases, Kentucky appears to have the most per capita in the country.

In 2015, the CDC reported that Kentucky was among seven states with more than twice the national average of hepatitis C incidence. This latest update shows that the state continues to manage its epidemic, which is largely driven by injection drug use and opioid addiction across the region.

However, the report also reveals that although hepatitis C rates rose sharply in Kentucky between 2006 and 2013, the numbers did appear to decline in 2014 and 2015. State health officials said this could reflect statewide efforts to increase knowledge about the virus among providers and drug users and how it can be spread via needle sharing.

Kentucky’s latest hepatitis C update also points out that more than 7,300 people have used the state’s syringe exchange programs since their legalization in 2015. Of those, more than 650 people received testing for HIV, and 609 were referred for substance abuse treatment.

Local harm reduction advocates say they will continue to push to open more of these sites to help combat Kentucky’s ongoing epidemic. So far, 24 needle-exchange sites are in operation across the state, and 9 others are in the midst of setting up.