In 2015, the Pendleton County Fiscal Court adopted a comprehensive policy for the creation and operation of a Harm Reduction Syringe Access Exchange Program as permitted by SB192 enacted by the KY General Assembly in 2015. Of the 120 counties in Kentucky, 36 are ranked in the top 100 at risk for serious disease outbreaks including HIV, and 54, or nearly half, are in the top 220 counties across the nation identified at risk⁴².  One of the primary objectives of the Hep C Elimination Plan in Kentucky is to increase and improve equitable access to harm reduction services across social and demographic areas particularly among people who use drugs.