Efficacy of Syringe Services Programs in Preventing the Spread of HCV

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Over the past two weeks, HEAL Blog has covered two separate counties within the state of California that have taken two very different approaches to dealing with access to Syringe Services Programs (SSPs) and the prevention of the spread of diseases such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV).

This past week, Here and Now, a program produced by WBUR, Boston’s National Public Radio (NPR) station, has also been covering issues related to SSPs in a series of interviews. These interviews included:

  • Chelsi Cheatom, Program Manager for Trac-B Exchange in Clark County, Nevada, which established the nation’s first syringe vending machine in Las Vegas, NV (Here and Now, 2018b);
  • Ricky Bluthenthal, Professor of Preventative Medicine at University of Southern California, who studies the efficacy of these programs (Here and Now, 2018a);
  • Danny Jones, Mayor of Charleston, West Virginia, who has led a very vocal campaign against the county health department’s Harm Reduction Clinic (Here and Now, 2018c)

Each of these interviews provides a set of perspectives that are very important to the discussion of SSPs, their efficacy, and their existence in the U.S. – an academic perspective that researches these issues and argues that data show these programs to be highly efficacious; a program worker who can attest to the successes and challenges of these programs; an elected official who must deal with and respond to the outcry and fallout of the very existence of SSPs creates in local settings. While each of these perspectives are important, it is Mayor Jones’ take on the issues in Charleston, WV with which I take issue.

Mayor Jones has, for the past five months, been waging a war against Kanawha County’s Harm Reduction Clinic, and he has, unfortunately, won. As of May 14th, the Clinic is now officially suspended by the state of West Virginia in response to an audit requested by Jones and Interim Health Officer Dr. Dominic Gaziano. The reasons for the suspension, and the findings of the audit, indicate that the clinic failed to build and maintain community support, lack of data indicating that drug users were actually informed of other programs (including treatment and recovery services), insufficient evidence to support the safe recovery and disposal of needles, and insufficient evidence regarding the total number and types of referrals made to drug treatment programs (Takitch & Hoak, 2018).

Kanawha-Charleston Health Department

Photo Source: WV Metro News

I began interviewing the head of the Kanawha County Clinic in September 2017 regarding the successes and challenges of establishing SSPs in the state of West Virginia. This Clinic, in particular, faced significant challenges because it served as one of only two public SSPs that served clients from 9 southern WV counties (Boone, Cabell, Kanawha, Lincoln, Logan, Mason, Mingo, Putnam, and Wayne). Since our conversation, two addition clinics have opened, but they are further East, and stilldo not serve those communities.

To put this into better perspective, here are some frightening statistics regarding HCV in those counties:

  • The rate of new Acute JBV infections in the state of West Virginia is 14.6 (per 100,000) – the highest rate in the nation
  • The rate of new HCV infections in the state of West Virginia is a staggering 7.2 (per 100,000) – the highest rate in the nation
  • The rates of HBV and HCV infection for the aforementioned counties are as follows (WVDHHR, 2018):
    • Boone – (HBV) – 34.2; (HCV) – 0.0
    • Cabell – (HBV) – 17.6; (HCV) – 10.3
    • Kanawha – (HBV) – 29.2; (HCV) – 14.9
    • Lincoln – (HBV) – 56.0; (HCV) – 0.0
    • Logan – (HBV) – 17.3; (HCV) – 8.6
    • Mason – (HBV) 25.9; (HCV) – 0.0
    • Mingo – (HBV) 31.6; (HCV) – 7.9
    • Putnam – (HBV) 28.1; (HCV) – 3.5
    • Wayne – (HBV) 14.6; (HCV) – 0.0
  • The state of West Virginia has an overall drug overdose death rate of 52.0 (per 100,000) – the highest rate in the nation
    • Roughly 86% of those overdose deaths were opioid-related
    • WV has the highest rate over opioid overdose deaths in the nation, with a rate of 44.9
    • These nine counties have the highest rates of drug overdose deaths in the state of West Virginia

To say that the burden placed upon the Kanawha/Putnam Harm Reduction Clinic was high is a gross understatement. If you notice the rate of HCV being lower in some counties, it’s because the state only requires that physicians offer HCV testing to people in the Birth Cohort (born 1945-1965) unless the physician knows about another risk factor in a patient, meaning that patients are disinclined to say they inject drugs. So, HCV cases very likely exist, there, but physicians are not required to test for it on a regular basis, which is dumb, given the high rates of Injection Drug Use in those counties.

In addition to serving essentially nine counties, the Clinic had to do so on a shoestring budget, as state law prohibits the use of funds for specific drug-related expenditures. They had to secure funding for syringes and disposal on their own, meaning significant time was spent fundraising to pay for the very reason why they were there.

Additionally, the Clinic repeatedly requested funds for the purchase and installation of Biohazard Disposal Kiosks – steel, locked mailboxes into which sharps can safely be disposed. Each individual unit costs around $1,500, which includes the cost of purchase, shipping, signage, and installation. The county refused to fund these kiosks (which didn’t stop the Mayor and Police Chief from complaining about the additional biohazard sharps waste around the city), and they were only able to secure funding for a single unit – funding which came notfrom the health department budget, but from the Emergency Medical Technician budget, who were kind enough to supply the funds.

The arguments being made by Mayor Jones and the Police Chief are understandable – there has been an increase in needle waste in the city of Charleston and the surrounding areas…in no small part, because the city steadfastly refused to pony up the funds to install disposal kiosks in these areas.

Additionally, both men argue that the privately run facility – Health Right – is doing a better job of providing the service. Perhaps, this is because each client has to be enrolled and create a paper trail to participate? For anyone who’s ever worked with, done research about, or been around People Who Inject Drugs (PWID), the last thing they want to do is create a paper trail that authorities can use to follow them back to their homes and arrest them for illicit drug use, possession, and possession of paraphernalia. This is why the Kanawha facility had exponentially more clients than Health Right – they weren’t creating a paper trail.

Did the Kanawha/Putnam County Harm Reduction Clinic have its issues? Absolutely. The program operated for barely three years, and there will always be a learning period. But, thanks to the unreasonable efforts of Danny Jones, PWID in those nine counties now get to enjoy traveling even further to obtain clean supplies.

Mark my words – this is going to have a serious deleterious impact on the already-highest-in-the-nation infection rates in the state of West Virginia.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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“OC” Shut Down the County’s Only Syringe Services Program

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Last week, HEAL Blog covered San Francisco’s multi-pronged approach to dealing with public health among People Who Inject Drugs (PWIDs) and health concerns related to Injection Drug Use (IDU). This week, we’ll visit the southern part of the state – Orange County.

Photo Cover of the OC Weekly

Photo Source: OC Weekly

For those unfamiliar with Orange County, either from the salacious Bravo “reality” series involving housewives, or from Disneyland, the OC is virtually the opposite of all things San Francisco. Long considered a Conservative bastion for the rich and ridiculous, Orange County is home to some of the most ludicrous local regulations and laws – regulating that street lights be turned off by 10 PM to avoid “light pollution;” regulating the length of grass and the design of doors on houses; one town attempted to ban flip-flops. The county has long been the butt of jokes, and deservedly so.

It should, then, come as no surprise, then, that Orange County recently shut down the county’s only Syringe Services Program (SSP) in Santa Ana in January 2018 by denying it a permit (Graham, 2018). This move came after a massive Hepatitis A (HAV) outbreak spanning the southern California coast from San Diego to Los Angeles (between which Orange County lies) primarily within homeless and PWID communities in 2016-2017. At the time, Orange County officials failed to follow the leads of San Diego, Santa Cruz, and Los Angeles Counties in declaring a public health emergency, deciding instead to continue with their protocol of vaccinating and educating their homeless population…which many cities within the county have criminalized (Vo, 2017). Not only did they fail to recognize that the HAV outbreak in surrounding counties could spread to them, they failed to enact any of the proactive sanitation recommendations put forth by the California Health and Human Services that were instituted in San Diego County.

Following this regressive trend, a permit request that would allow the establishment of a mobile SSP in Costa Mesa’s Westside is currently attempting to raise botoxed eyebrows. The justification used by Santa Ana to January permit denial was an “increased number of discarded syringes in the area.” Costa Mesa officials called the proposed mobile SSP a “magnet for drug users” (Fry, 2018).

…because there are no drug users originating from Orange County…

The proposed mobile SSP would serve four Orange County cities – Santa Ana, Anaheim, Orange, and Costa Mesa. These cities were chosen because the Orange County Health Care Agency depicted them as being hotspots for HIV and drug overdoses (Brazil, 2018). Anaheim had the highest number of opioid-related overdose deaths between 2011-2015, followed by Huntington Beach, Santa Ana, Costa Mesa, and Orange. Santa Ana has the highest rate of HIV cases, while Costa Mesa and Orange also have high rates.

Syringe Exchange Program worker providing assistance

Photo Source: LA Times

As for Hepatitis C (HCV) and Hepatitis B (HBV), California, as a whole, has relatively low rates of both – 0.2 and 0.3, respectively. Moreover, the state consistently runs behind on issuing annual reports and epidemiological profiles – the most recent HCV report was issued in 2016, and counts only Chronic HCV cases, which is counter to how the Centers for Disease Control and Prevention (CDC) accounts for HCV counts and rates in the U.S. (they count Acute HCV cases, as Chronic HCV is a long-term disease that is hard to track and may take years to develop). When states account for Chronic HCV cases in their reporting, rather than Acute infections, the data tends to skew toward patients within the Birth Cohort – Baby Boomers born between 1945-1965. This inevitably will wind up excluding PWID and homeless populations, as they are less likely to be screening for HCV, and data from virtually every state in the U.S. indicate that PWID who contract HCV trend younger – 15-45.

The justification in Costa Mesa for denying permits to the Orange County Needle Exchange Program – that it will attract drug users to their fair cities – is ludicrous on several fronts, not the least of which is the simple issue of distance. Anyone who’s ever lived in southern California can tell you that it will likely take you an hour or more to get somewhere during the daytime, and that’s if you’re driving. The suggestion that a mobile SSP will somehow draw PWID from neighboring counties – from Los Angeles, San Bernardino, San Diego, or Riverside, all of which are wellout of walking distance – is just ridiculous.

If the Real Housewives of Orange County taught us anything, it’s that keeping up appearances in Orange County is more highly regarded than adequately addressing serious issues. Orange County, rather than being proactive and attempting to directly confront HIV, HBV, and HCV, are instead trying to maintain the façade of a Pleasantville-esque paradise, where the homeless are invisible and drug users mustbe coming from othercounties. It’s a shortsighted approach, destined to produce lackluster results.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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San Francisco: A Case Study in Multi-Pronged Approaches

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

One of the most frequent drums HEAL Blog likes to bang is that epidemics do not occur in siloes. As we learned in Scott County, Indiana, an uptick in new HIV and Hepatitis C (HCV) cases was largely the result of the Injection Drug Use (IDU) of the now-removed-from-the-market prescription opioid drug, Opana. The HIV community has been banging this drum since the 1980s; unfortunately, the politics around IDU were such that Syringe Services Programs (SSPs, or needle exchanges) simply weren’t a politically feasible reality in most of the United States. In other parts of the country, like San Francisco, underground exchanges began in the late-80s, and legalization was relatively quick to follow.

Needle exchange program with volunteers working with injection drug users

Photo Source: 5KPIX CBS

San Francisco’s first underground needle exchange – Prevention Point –  began in 1988 when a group of friends realized that something needed to be done to stop the spread of HIV among People Who Inject Drugs (PWIDs). Against California law, the organizers and volunteers went to great lengths to provide sterile syringes to PWIDs and also partnered with researchers, collecting data to document the positive health benefits programs like theirs could achieve (San Francisco AIDS Foundation, n.d.). Prevention Point operated for four years underground until 1992, when then-mayor Frank Jordan declared a public health emergency in the city of San Francisco and committed $138,000 to Prevention Point. This bold step went a long way to ensuring that SSPs were legalized within the state of California.

Fast-forward to 2018, and again, IDU is again a serious issue in San Francisco. This time, however, the San Francisco Department of Public Health is leading the charge using a variety of integrated initiatives involving:

opioid overdose prevention, education, and the distribution of Naloxone [an opioid overdose reversal drug]; access to and distribution of [sterile] syringes; prevention, screening, and treatment of HIV and HCV; alcohol prevention; and the creation of a Harm Reduction training institute (Chaverneff, 2018).

This multi-pronged approach to dealing with these intertwined epidemics using community-based methods, including peer education and testing models that have proven effective in other settings around the world.

More importantly, their model also includes taking HCV treatment outside of traditional healthcare settings, and helps to provide treatment at an Opiate Treatment Outpatient Program (at University of California San Francisco), at the San Francisco County Jail, at the SF AIDS Foundation Syringe Exchange program, at Magnet (a gay men’s sexual health clinic), at shelters, and in street settings (mobile setups). Of these, the most notable success was that the 10 patients who began HCV therapy in shelters all completed treatment; conversely, less than half of the 100 inmates who began HCV therapy completed treatment (Burk, 2018).

This model has been working for San Francisco, and it has the potential to work around the country, as well.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On Wednesday, April 26th, 2018, Elizabeth Paukstis, Public Policy Director for the National Viral Hepatitis Roundtable (NVHR), joined me in Washington, DC to deliver presentations about Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C. This was the second such meeting held by the Community Access National Network (CANN) in as many years dedicated to the topic of correctional healthcare.

My presentation – Viral Hepatitis in Correctional Settings – included original research conducted by CANN that attempted gather the testing protocols for Hepatitis B (HBV) and Hepatitis C (HCV) from Departments/Divisions of Corrections (DOCs) in all fifty states and the District of Columbia. The findings of this research are as follows:

  • Only fourteen (14) states publicly post specific protocols on their state DOC websites
  • Twenty-five (25) states require or offer HBV testing during intake
  • Thirty-two (32) states require or offer HCV testing during intake
  • Only seven (7) states follow the Federal Board of Prisons’ (BOP) recommendation of offering HBV testing using an Opt-Out delivery model (informed refusal)
  • Only fifteen (15) states offer HCV testing using an Opt-Out delivery model
  • Twenty-three (23) states only test for HBV on inmate request or if they meet clinical criteria (e.g. – inmate has HIV, contact with someone who has HBV, injection drug use)
  • Seventeen (17) states only test for HCV on inmate request or if they meet clinical criteria (Hopkins, 2018)

My report can be found here.

State/Federal HCV-Related Lawsuits Involving Prisons (2017-2018)

Photo Source: CANN

Ms. Paukstis’ presentation – Hepatitis C and Incarceration: Policy Proposals and Challenges – focused on treatment statistics within prisons, the challenges prisons face when procuring prescription drugs, provided a case study regarding Mississippi’s myriad issues related to HCV in their prison populations. Highlights of this presentation include:

  • An estimated 17% of inmates in U.S. state prisons are infected with HCV
  • Less than 1% (0.89%) of those known to have HCV were receiving treatment in 2016
  • The Federal BOP receives at least a 24% discount on HCV drugs – a discount to which state prisons are not privy
  • State prisons are not eligible for discounts under the Federal 340B Drug Pricing Program
  • Incarcerated persons face an additional risk of having their sentences extended if they are charged with “endangerment by bodily substance” (causing a correctional employee, visitor, or another inmate to come into contact with blood, seminal fluid, urine, feces, or saliva)

Download Elizabeth’s report.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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CDC Releases 2016 Viral Hepatitis Surveillance Data

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

…and the news isn’t good.

The U.S. Centers for Disease Control and Prevention (CDC) released, last week, the 2016 Viral Hepatitis Surveillance report. Acute Hepatitis B (HBV) infections remained largely stable, while Acute Hepatitis C (HCV) saw a 21.8% increase in new infections from 2015 to 2016. The CDC attributes the continually rising incidence of HCV to rising rates of Injection Drug Use (IDU) and, to a lesser extent, improved case detection (CDC, 2018b).

Photo of the CDC Headquarters

Source: George Mason University

According to the CDC, HCV has seen a 350% increase from 2010 (CDC). Despite this increase, nearly 1 in 5 states do not gather, track, or report HCV data. In 2015, eleven states did not deem HCV a reportable condition; in 2016, that number decreased to nine state (AK, AZ, DC, HI, IA, MS, NH, RI, & WY), as both Connecticut and South Dakota began surveilling the disease. This collection of states is particularly concerning, as many of them are in areas of the country where the burden of infectious disease is high – two states in New England, one in the Midwest, two in the South, and Arizona, which has the 6th-highest incarceration rate in the nation.

This last point is important, as it is estimated that 1 in 3 in U.S. jails and prisons has HCV. Arizona’s high rate of incarceration is particularly troubling, given the ongoing class-action lawsuit against the Arizona Department of Corrections (ADC), Parsons v. Ryan (2012), which not only found that ADC systematically refused to treat inmates, but failed to provide even basic healthcare services. Worse, last year saw both an additional post-settlement hearing in which ADC employees were further accused of both retaliating against inmates who testified, and violating the terms of the settlement in 2,127 incidents (Weill, 2017).

Arizona Department of Corrections is killing prisoners

Photo Source: Survivors of Prison Violence – Arizona

Other troubling statistics involve the changing face of HCV. The three largest increases in new infections occurred in people aged 40-49 years (33.3%), 30-39 years (29.4%), and 20-29 years (12.5%). All of these groups fall outside of the Birth Cohort – Baby Boomers born between 1945-1965 – and indicate that non-medical exposure is likely to be the largest cause of new infectious. More troubling was that people aged 20-29 had the highest rate of infectious of any age group (2.7). This is likely attributable to IDU.

As for race demographics, American Indians and Alaskan Natives are disproportionately impacted by HCV, as a percentage of the population, with an infection rate of 3.1 per 100,000.

More concerning for advocates is that 52.5% of the Acute HCV cases reported to the CDC did not include risk factor data, meaning that states aren’t doing their due diligence during testing/reporting. Of those that did include risk factor data, the data suggest that IDU is the leading risk factor for transmission, with 68.6% of new HCV infections listing IDU as the primary risk factor.

Clearly, the U.S. has more work to do, when it comes to identifying HCV infections. Realistically, it is uncertain that much support will be coming from the Federal level, as even the most benign legislation winds up stalled for whatever reason. Until the composition of the Federal legislature occurs, states will end up shouldering most of the burden in the interim.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Trump’s War on the Poor is a War Against Us

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On April 10th, current President, Donald J. Trump, fired the latest Republican salvo against the poor and social welfare programs by signing an executive order intended to force recipients of food assistance, Medicaid, and low-income housing subsidies to “get a job” or lose their benefits. A question that has yet to be answered is whether or not this edict will apply to recipients of Ryan White benefits, which provide low- or no-cost HIV medications, medical and dental treatment coverage, and other ancillary, yet vital services to an estimated 52% of people diagnosed with HIV in the United States (Health Resources and Services Administration, 2016). Those co-infected with Hepatitis C (HCV), whose cure requires treatment with some of the most expensive drugs on the market, are likely to be harmed, as well.

Make no mistake – this latest royal decr…executive order – unironically titled, “Reducing Poverty in America” – is specifically designed notto actuallypull people up out of poverty, but to force the “undeserving” off of the public dole. The order is directed at “any program that provides means-tested assistance or other assistance that provides benefits to people, households, or families that have low incomes” (Thrush, 2018). This is concerning for healthcare advocates, because the qualification for Ryan White services is predicated upon “means-tested assistance.” Essentially, how much money you make determines if you’re eligible for coverage.

Recent HCV incidence and prevalence reports indicate that an increasing number of new infectious occur in rural and suburban areas of the country, with higher rates of infection occurring in Injection Drug Users, particularly in people aged 18-45, and in areas where unemployment is high, educational achievement is lower, and access to healthcare services often faces several barriers. Essentially, HCV is prevalent among people and in places that are poor; people who often rely upon means-tested assistance to pay for healthcare.

As with virtually every Republican-initiated attempt to “reform” social services programs, this is a solution looking for a problem. Roughly 60% of working age, non-elderly Medicaid enrollees are working; plus, nearly 8 in 10 –  recipients (78%) live in families where at least one person works (Garfield, et al, 2018). The statistics are similar for recipients of the Supplemental Nutrition Assistance Program (SNAP)…  And for WIC…  And for virtually every other social safety net program.

76% of Louisiana's Medicaid expansion enrollees are working, caring for family members, or in school.

Photo Source: Louisiana Budget Project

Ryan White recipients, in particular, face an undue burden, as income requirements – particularly in more conservative states – are so low that working virtually any job will make them ineligible to receive coverage for medications that are prohibitively expensive. This will apply to both those mono-infected with HIV and co-infected with HCV.  For those receiving Medicaid, the burden will be just as high.

All of this stems from the Federal Poverty Level (FPL), a percentage of which determines eligibility for these means-tested programs. For an individual, the FPL is $12,140 per year in 2018. This means that an individual must make that amount, or less, to be considered “in poverty” in the United States. In states that expanded their Medicaid programs, most raised that qualification limit to 138% percent of the FPL ($16,753). The FPL percentage for Ryan White varies wildly from state to state.

This places potential recipients in a terrible position: At the current Federal Minimum Wage ($7.50/hour), an individual working 40 hours a week for 52 weeks will have an annual income of $15,080. If they cross this threshold by even a few hundred dollars, it makes them ineligible for the program, but still leaves them unable to afford the basic cost of living, much less any insurance premiums or medications they may have added to their monthly expenditures. Even with a second income, which would likely make them ineligible for services because they make “too much money,” the cost of living is so far removed from how the FPL is set, no person can reasonably expect to subsist off of that amount for any extended period of time in a First World country.

Adding work requirements to social programs also poses a logistical reality: simply demanding that “able-bodied” people “get jobs” doesn’t magically create jobs for there to be gotten. Nor are these requirements bolstered by any additional wraparound services, such as increased infrastructure spending to extend public transportation services out to far-flung locales, transportation assistance funds to cover the cost of fuel or low-cost public transportation passes.

The reality is that these “cost-saving” measures (ultimately designed to purge these programs of ‘undeserving’ recipients) will result in immeasurable costs that will be paid in human lives.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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We Have a Cure for HCV; Few People Can Get It

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Numerous films and novels have predicted this fate: there’s a fatal disease and someone invents a cure, but nobody can get it, and people die because of it. It’s a metaphor about the dangers of unchecked capitalism – the greedy owner of the cure who holds the rest of the world hostage until his demands are met.

And here it is – 2018, and we’ve had a cure for Hepatitis C (HCV) that’s easily tolerated since 2013, but it’s so prohibitively expensive that private and public payors, alike, have strictly limited access to it. They make patients, physicians, and pharmacists jump through as many hoops as possible to get the cure, from the strictest prerequisite abstinence guidelines, to allowing the disease to progress until it’s “bad enough” to cover it.

Medical Benefits Claim Form with the word, "REJECTED"

Photo Source: NPR

Sure, the cost of the newest drugs to cure HCV have dropped to ¼ of the introductory price of Sovaldi (Gilead), but, still – $30k for eight weeks of treatment? That’s still prohibitively expensive, even with the deep discounts and rebates given to many payors by manufacturers during the negotiation process. Those expenditures are only going to increase.

Now, there is evidence suggesting that undiagnosed HCV is more prevalent than undiagnosed HIV (Torian et al, 2018). Since the 1990s, hospitals and emergency departments have actively touted “routine HIV” screening, but have failed to deliver on those promises:

Lessons from HIV are both instructive and sobering: routine HIV screening is not truly routine; linkage continues to challenge even experienced providers; and linkage and treatment initiation vary widely across sites (Torian et al, 2018).

The findings from this study indicate not only a need to increase screening and linkages to care for HIV, but that this increase needs to be spread to HCV, as well. The latter argument, while correct, is unlikely to occur, in no small part because states and patients simply don’t have the resources to successfully implement this type of public health initiative.

Beyond just testing, minorities and Medicaid recipients – a significant portion of those infected with HCV – enjoy some of the lowest treatment rates in the nation (Wong et al, 2018). Hispanic patients were siginifantly less likely to receive treatment for HCV than white patients, and those on Medicaid, state insurance, or indigent care or no insurance were significantly less like to receive treatment than those with commercial insurance.

That last part comes to a head in rural America, where patients are far likelier to rely upon Medicaid as their primary payor for medical services, and where Injection Drug Use (IDU) of prescription opioids and/or heroin is high. In states like Ohio, Indiana, West Virginia, and Kentucky, IDU and rates of overdose go hand in hand with increased rates of both Hepatitis B and HCV.

The sad reality is that, given the existing political makeup of both state and Federal legislatures, it’s highly unlikely that the significant resources needed to effectively combat the spread of HCV will be allocated. At a time when budgets are being slashed in order to accommodate tax cuts for corporation and the wealthy, to suggest that conservative lawmakers are suddenly going to provide an exponential (or even incremental) increase in funding is unrealistic.

References:

  • Torian, L.V., Felsen, U.R., Qiang, X., Laraque, F., Rude, E.J., Rose, H., Cole, A., et al. (2018, April 04). Undiagnosed HIV and HCV Infection in a New York City Emergency Department, 2015. American Journal of Public Health 108, no. 5 (May 1, 2018): pp. 652-658. DOI: 10.2105/AJPH.2018.304321 Retrieved from: https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304321
  • Wong, R.J., Jain, M.K., Therapondos, G., Shiffman, M.L., Kshirsagar, O., Clark, C., & Thamer, M. (2018, March 09). Race/ethnicity and insurance status disparities in access to direct acting antivirals for hepatitis C virus treatment. The American Journal of Gastroenterology. DOI: 10.1038/s41395-018-0033-8. Retrieved from: https://www.nature.com/articles/s41395-018-0033-8

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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