Seven months after health officials in Knoxville, Tennessee, launched a major hepatitis C virus (HCV) testing push in health departments across the county, they have discovered that up to 10 percent of locals are infected with the liver virus, The Knoxville Focus reports

The report further confirms that the U.S. Appalachian region has some of the highest hep C rates in the country.

The overall incidence rate for hepatitis C across the United States is approximately 1.3 percent, with up to 3.5 million Americans estimated to be currently living with the virus, according to the Centers for Disease Control and Prevention (CDC). That means Knoxville’s HCV rate is up to 10 times higher than the national rate. Tennessee health officials also note that the state’s rate of acute hepatitis C has more than tripled since 2009—largely due to an increase in injection drug use.

These latest data came to light after the Knox County Health Department (KCHD) began incorporating hepatitis C screening into most of its preventive clinical offerings in June 2016. So far, more than 3,000 people have been tested in the community. The citywide push was made possible through funding from the Tennessee Department of Health and HCV drugmaker Gilead Sciences.

“To effectively address hepatitis C in our community, we must have a better understanding of the scope of this epidemic locally,” said KCHD clinical services director Kelly Cooper, MD. “Compared to the rest of the country, the highest rates of hepatitis C are estimated to be in Appalachia. And this is exactly what this preliminary data from Knox County is showing us.”

Local health officials have since recommended HCV testing for everyone born between 1945 and 1965 and anyone with a history of intravenous or intranasal drug use. Testing is also recommended for all locals treated for a blood clotting problem prior to 1987, those who received a blood transfusion or organ transplant before 1992, HIV-positive people and anyone with an abnormal liver test or other liver disease.

For now, hepatitis C testing is free for all KCHD patients without health insurance. In addition to screening and education, Knoxville’s hepatitis C program works to identify and connect people to treatment.