Increase in HIV Seen During Chicago Area COVID Testing

By: Marcus J. Hopkins, Policy Consultant

A new abstract presented in late October 2020 found that new diagnoses of HIV more than doubled in 13 healthcare centers located on the South and West Sides of Chicago when patients presenting for COVID-19 testing were also tested for HIV (Stanford, Schmitt, Taylor, Eller, Friedman, McNulty, Ridway, Hazra, Michelle, Beavis, & Pitrak, 2020).

This testing effort was undertaken using a preexisting model of automatically testing incoming patients presenting for influenza symptoms, expanding that model to include patients presenting for COVID-19 – an effort that found the rate Acute HIV Infections (AHI) to be significantly higher during COVID-19 testing than in the four previous years – 14.4 (per 100,000) in 2020, compared only 6.8 per year from 2016-2019. AHI patients comprised 25.7% of all new HIV diagnoses – the highest percentage, ever. (Stanford, et al, 2020).

Stage of HIV Infection

Photo Source: health.codify.club

Elsewhere in the U.S., COVID-19 has had a net negative impact on the number and frequency of HIV tests being offered, as virtually all providers have shifted their collective foci to be on COVID-19, which presents a higher short-term mortality rate. This is true across every healthcare setting and across population settings (e.g. – urban, suburban, rural). The concern, here, is that, while everyone’s eyes are on COVID-19, HIV (as well as Viral Hepatitis) will continue to spread relatively unchecked.

In states that were experiencing increases in HIV and Viral Hepatitis diagnoses (such as West Virginia) regular testing has all but ceased. Despite this lack of regular testing, what testing is being done is turning up higher than average numbers of new HIV diagnoses. In West Virginia, for example, with severely reduced testing frequency, there have been 93 new HIV diagnoses in 2020, as of October 22 (Office of Epidemiology and Prevention Services, 2020). Until 2018, the annual number of new cases averaged out to 67 new diagnoses per year.

The decreased testing for HIV is concern, but equally concerning is the decrease in Viral Hepatitis testing – diseases that are more efficiently transmitted and less frequently tested. In many states, Hepatitis B and C testing are treated as an afterthought, already; with the onset of COVID-19 and the switch of focus it has required to deal with the eminent threat to health and human safety, chronic diseases are receiving less attention than ever before, in terms of testing urgency.

Concerns continue to be voiced that, once the COVID-19 threat has passed and we return to some sense of normalcy, we will find that rates of new HIV and Viral Hepatitis diagnoses will explode, as patients who would normally have been tested during non-COVID conditions delayed or were not offered testing during the pandemic.

References:

  • Office of Epidemiology and Prevention Services. (2020, October 22). HIV Diagnoses by County, West Virginia, 2018-2020. Charleston, WV: West Virginia Department of Health and Human Resources: Office of Epidemiology and Prevention Services: HIV and AIDS: Increase in HIV. https://oeps.wv.gov/hiv-aids/documents/data/WV_HIV_2018-2020.pdf
  • Stanford, K., Schmitt, J., Taylor, M. M., Eller, D., Friedman, E., McNulty, M., Ridway, J., Hazra, A., Michelle, M., Beavis, K., & Pitrak, D. (2020, October 24). LB-6 – Increased Diagnoses of Acute HIV Infection through Routine ED Screening and Rapid Linkage to Care and initiation of HAART During the COVID-19 Pandemic. IDWeek. https://www.eventscribe.net/2020/IDWeek/fsPopup.asp?Mode=presInfo&PresentationID=798014

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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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Incidence of HCV High Among Young PWID in NYC

By: Marcus J. Hopkins, Policy Consultant

A study released in the Journal of Viral Hepatitis found that, of the 539 young study participants in New York City, prevalence of Hepatitis C (HCV) was high and that many had never been tested (Kapadia, Katzman, Fong, Eckhardy, Guarino, & Mateu-Gelabert, 2020).

Hepatitis

Source: Journal of Viral Hepatitis

This study, conducted between 2014 and 2016, engaged participants aged 18-29 who reported non-medical opioid and/or heroin use in the prior 30 days. Of those participants, 353 were People Who Inject Drugs (PWIDs) and 186 non-PWIDs. Of the PWID participants:

  • The median age was 25;
  • 65% were male;
  • 73% were non-Hispanic Whites;
  • 20% had never been tested for HCV, and;
  • 25% tested positive for HCV

From these data, we can draw a number of conclusions:

  • Even in metropolitan areas, like New York City, where services are plentiful, seroprevalence of HCV is high amongst PWID;
  • Either the population studied was recruited using a method that inadvertently favored the selection of non-Hispanic Whites, or that demographic representation is also representative of who is injecting drugs in the U.S.;
  • The percentage of PWID who had not been tested for HCV is reflective of excellent outreach within those communities in New York City; even still, 1 in 5 PWID had not been tested for HCV.
    o That trend will not continue in rural areas, where access to testing services is virtually unavailable in many rural counties.

This study needs to be replicated in suburban and rural regions, even though the sample sizes will be smaller and more difficult to find, recruit, and retain in the studies. Those difficulties do not, however, mean that they should not be done.

References

  • Kapadia, S. N., Katzman, C., Fong, C., Eckhardt, B. J., Guarino, H., & Mateu-Gelabert, P. (2020). Hepatitis C Testing and Treatment Uptake among Young People who Use Opioids in New York City: A Cross-Sectional Study. Journal of viral hepatitis, 10.1111/jvh.13437. Advance online publication. https://doi.org/10.1111/jvh.13437

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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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Inmates with Hepatitis C in Missouri & Nevada to Get Treatment, Finally

By: Marcus J. Hopkins, Policy Consultant

The Missouri Department of Corrections (MODOC) has finally had its settlement agreement approved by a federal judge in Pastawko v. Missouri Department of Corrections, one of over a dozen class action lawsuits filed since 2013 by inmates against state DOCs demanding treatment for Hepatitis C (HCV) (Rivas, 2020).

MO Department of Corrections

MODOC and its contracted healthcare provider, Corizon, have agreed to spend $50 million to test and treat inmates living with HCV, to share the test results with inmates, give inmates living with HCV free access to their medical records, and MODOC has agreed to revamp their testing practices and procedures.

You might notice, in that previous statement, that the agreement requires the state to share access to test results and free access to their medical records. This is because MODOC inmates were not granted access to their test results and had to pay to access their medical records.

In the Western part of the country, lawmakers in Nevada approved $7 million for Phase 1 of a program to cure Nevada’s inmates of HCV (Dornan, 2020). This multi-phase program will, after all is said and done, require $36.7 million to cure all of Nevada’s inmates, and this first phase will treat 400 inmates between now and April 2021.

NV Department of Corrections

The number of inmates treated will include more than 2,400 who are required to be treated.

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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Breaking Down Silos Between Disease States

By: Marcus J. Hopkins, Policy Consultant

The concept of intersectionality is one that has permeated social sciences in the thirty-one years since the phrase was coined (1989). This concept is that social categories, such as race, class, and gender, are fundamentally interconnected and that intersection creates overlapping and interdependent systems of discrimination or disadvantage. Basically, a person of color who has a lower income and is gender non-conforming doesn’t face discrimination just because of their race, or just because they’re poor, or just because they don’t conform to gender norms, but that they face all three, simultaneously, which creates a greater burden.

While this concept was been embraced by the vast majority of social scientists as being valid and worthy of being addressed using multi-tiered approaches, the medical landscape – at least in the United States – remains a largely siloed industry.

So, let me unpack that:

I’ve been living with HIV for the majority of my adult life, and in that time, the only doctors I have seen with any regularity have been my Infectious Disease (ID) specialists. Only since relocating to West Virginia and going to an HIV clinic that’s situated in a hospital have I ever been offered (or sent to) a General Practitioner (GP), and that was for a blood pressure issue due to the weight I say I’ve put on since quitting smoking, which does play a part, but which is far likelier due to the fact that I work from home and have absolutely no desire to step foot into a gym or hope on the stationary recumbent cycle that serves as my pillow stand and clothing rack. The one time – literally, one time – that I’ve actually been to see my GP, he tried to prescribe me a blood pressure medication that had a counterindication with my HIV medication.

This is why many People Living with HIV (PLHIV) simply forego having other doctor, except those that treat other conditions that require another specialist – the vast majority of health issues are thought to be related to their HIV, and are therefore dealt with by the ID doc. Need a flu shot? ID doc. Have the flu? ID doc. Feeling depressed? Get a consult, but the ID doc prescribes your antidepressants. Moreover, going to other doctors, for many PLHIV, is just an additional co-pay they can’t afford and a trip to a second or third location they don’t have time or energy to make.

So, when I talk about intersectionality in terms of healthcare, what I’m really talking about is not doing away with “specialists,” per se – but recognizing that, particularly in rural Appalachia, the patient you figuratively touch to treat for HIV, also has a high likelihood of being the same patient in need of treatment for several comorbid conditions, including Substance Use Disorders.

But, the way in which we fund testing, treatment, and surveillance of these diseases, in terms of federal and state funding, has create a landscape where SUDs are often treated in isolation from Infectious Diseases, like HIV and Viral Hepatitis.

National Survey of Substance Abuse Treatment Services

According to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) most recent National Survey of Substance Abuse Treatment Services (N-SSATS) 2019 survey, the following frightening data are true of the 15,961 SUD treatment facilities who responded:

  • Only 31.4% offered HIV testing;
  • Only 9.6% offered Hepatitis A (HAV) vaccination;
  • Only 9.5% offered Hepatitis B vaccination;
  • Only 26.9% offered HBV testing;
  • Only 30.6% offered Hepatitis C (HCV) testing.

Worse, still:

  • Only 8.2% of facilities provided treatment for HIV
  • Only 8.9% of facilities provided treatment for HCV

The other side of that equation is equally true: most ID clinics, treatment facilities, and providers are not providing SUD treatment services, simultaneously. Because of the way that SUD has been lumped (accurately or inaccurately) in with “mental” / “behavioral” health, ID providers and general practitioners are generally not situated inside of or near the same treatment facilities.

In both cases, even with patient referrals, getting patients being treated for SUDs to follow up on and show up for appointments at a separate location on a different day to be tested or treated for HIV and/or Viral Hepatitis. The reverse is true, as well, particularly for patients without a permanent address, without a steady income, and with no insurance.

In Kentucky, a research study has found some success with locating an SUD treatment program within the University of Kentucky’s ID clinics, focusing on treating bold diseases simultaneously, rather than in isolation. Patients get referred to these programs from a variety of locations, including from the state’s many Harm Reduction Programs, and of the 270 patients referred to these combination clinics, 78 have actually enrolled. Of those, about 25% of begun treatment for SUD using Medications for Opioid Use Disorder (MOUDs) – the term that is coming to replace Medication-Assisted Treatment (Gever, 2020).

healthcare_silos_v2

Photo Source: cardinaldigitalmarketing.com

Across all branches of medicine, evidence shows that making treatment easier to access, easier to undergo, and making regimens simpler result in higher treatment adherence and better health outcomes. This is true in all healthcare settings, and we must work to deconstruct the testing, treatment, and service silos that exist between HIV, Viral Hepatitis, and Substance Use Disorders.

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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Nation Sees Bipartisan Support for Syringe Services Programs

By: Marcus J. Hopkins, Policy Consultant

A new report released by the Bipartisan Policy Center (BPC) examined how federal funds have been spent to confront our nation’s opioid addiction epidemic.

BPC_Logo_1920x1080The report found the following:

  • Provisional Drug Overdose Death data for 2019 indicates a 4.9% increase over 2018 slight decline;
  • Local reporting from states and counties indicate that deaths are continuing to increase, in 2020, with many pointing to the COVID-19 Pandemic serving as one of the reasons for increases in drug use as a coping mechanism;
  • Synthetic opioids (e.g. – fentanyl) continue to be the leading cause of opioid-related overdose deaths;
  • Multiple substances, including methamphetamine and cocaine, are increasingly being found along with opioids in overdose death toxicology (i.e. – Polysubstance-Involved Deaths);
  • Total federal funding for Fiscal Year (FY) 2019 increased 3.2% from 2018 to total $7.6 billion;
  • Three-quarters of funding went to treatment, recovery, and prevention services; the remainder went to research, interdiction, law enforcement, and other criminal justice activities, with a 9% of funding to interdiction efforts (disrupting supply chains and trafficking);
  • Medicaid spending for Medications for Opioid Use Disorder (MOUDs) and the opioid overdose antidote, naloxone, increased by 15% to nearly $1.6 billion in 2019;
  • Opioid spending in just six states totaled 11% of federal funding in 2019;
  • Per capita federal opioid funding averaged $25 in 2019. (Hoagland, Parekh, Burgos, et al, 2020).

The BPC report notes that, while federal funding has increased, the rate of funding has not increased at the same rate of the severity of the problem(s), and that the funds are not targeted in a such a way that allows for flexible responses at either the state, or federal levels, for federal grants to be targeted at the programs that are most effective, or in ways that result in better outcomes and lower drug overdose deaths.

Two hands, with one hold a needle

Photo Source: TheBody.com

Additionally, this report finds that law enforcement funding and efforts should be retargeted to focus less on arrest and incarceration, and more on linkage to treatment and recovery services.

The BPC makes the following policy recommendations:

  • Increase funding for the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Block Grant (SABG) funding for evidence-based programs;
  • Coordinate federal government harm reduction services and remove the restrictions from purchasing syringes currently in federal appropriations language;
  • Remove restrictive funding language in federal grants to allow general spending on Substance Use Disorders (SUD) that will allow for treatment beyond just opioids;
  • Reform law enforcement efforts to move away from incarceration and prosecution, and increase access to and linkage efforts to SUD treatment;
  • Increase access to MOUDs and other SUD treatment in correctional healthcare settings and increase linkage to treatment during the reentry process;
  • Extend and make permanent regulatory flexibilities put in place in response to the COVID-19 Pandemic that have allowed for certain SUD treatment services to be conducted via telemedicine;
  • Remove special licensing requirements for health care providers to prescribe buprenorphine;
  • Increase Medicaid reimbursement rates to encourage additional providers to offer SUD treatment and services

References

  • Hoagland, G. W., Parekh, A., Burgos, A., Armooh, T., Ballie, M., Chen, E., LaBelle, R., & Swope, T. (2020, September). Tracking FY2019 Federal Funding to Combat the Opioid Crisis. Washington, DC:

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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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States Continue to Limit Access to Hepatitis C Treatments

By: Marcus J. Hopkins, Policy Consultant

Many patients living with Hepatitis C (HCV) continue to be denied access to curative Direct-Acting Antivirals (DAAs) in the United States. Throughout the U.S., state Medicaid programs and Departments of Corrections (DOCs) limit access to DAA drugs – the standard of care for people living with HCV – using a variety of Prior Authorization (PA) requirements, including the following:

BARRIERS

Photo Source: eurotruss.com

Prescriber Requirements – these restrictions limit which physicians may prescribe DAA drugs to patients in order for Medicaid programs to approve paying for the treatment. This requirement essentially overrides the FDA rule allowing for any physicians to prescribe DAA drugs, demanding that any physician withing to prescribing them either be a Gastroenterologist, Hepatologist, or Infectious Disease specialist, or prescribe the drugs in consultation with one of those specialists. If those conditions are not met, Medicaid will automatically deny the claim for treatment.

In other nations, such as Australia – the country that has, to date, been the most successful nation in treating and curing HCV within its population and is slated to not only meet, but beat the WHO goal of eradicating HCV by 2030 – HCV DAA prescribing rights has been expanded to include Registered Nurses (RNs), with increases the number of providers able to treat people living with HCV.

By comparison, the U.S., in no small part because of our 20th Century approach to healthcare in a 21st Century landscape, has been slow to remove PA requirements from Medicaid formularies, though incremental progress has been made.

Double Polymerase Chain Reaction (PCR) Tests – these restrictions require that providers submit two HCV Ribonucleic Acid (RNA) PCR tests over a predetermined period of time (usually six months) to establish whether or not a patient has Acute or Chronic HCV.

The “justification” behind this barrier is the fact that roughly 25% of patients diagnosed with Acute HCV experience what is known as “Spontaneous Clearance.” HCV is present in a patient’s blood 2 to 14 days after initial exposure and may be detected using an HCV RNA PCR test. In this 25% of patients, Spontaneous Clearance – when the body successfully clears the body of the infection without treatment – within 6 to 12 months (Grebely, Prins, Hellard, Cox, Osburn, Lauer, Page, Lloyd, & Dore, 2012).

HCV RNA PCRs can detect the levels of HCV in the blood. Double PCR PA requirements are sold as “cost containment” measures, the assumption being that, if patients know that Medicaid will pay to treat and cure their HCV, there will be a “run” on treatment requests.

The problem with the Double PCR requirement is twofold: (1.) the current treatment guidelines (here) recommend treating HCV regardless of whether or not the infection is Acute or Chronic, and (2.) the primary risk factor in nearly 80% of new HCV infections is Injection Drug Use (IDU). People Who Use Drugs (PWUDs) are a notoriously hard to reach/hard to treat patient population, just for general healthcare services. If getting this patient population into basic healthcare appointments is difficult, engaging them in specialty care is exponentially harder. Expecting this population to come in for an initial PCR test, wait for six months, come back for a second PCR test, have that test submitted for treatment approval, and then, come back a third time to initiate HCV treatment (if treatment is approved) is a proposition that is almost certain to fail.

The true purpose behind this requirement is not to contain costs, but to create a barrier to treatment that will ensure that Medicaid doesn’t have to pay for treatment.

Substance Abstinence – these requirements demand that prospective patients abstain from all drug and alcohol consumption for a predetermined period of time (usually between 6 to 9 months). This barrier is often accompanied by an additional requirement that these patients also enroll in a Substance Use Disorder (SUD) treatment program or enter counseling for SUD…whether or not the patient actually has an SUD.

This barrier is designed to prevent patients with SUDs from beginning treatment and abandoning it, halfway through the treatment period (between 8 to 12 weeks, for most patients). The thinking behind this is that people living with an SUD are less likely to be compliant with medication regimens, and therefore are not good candidates for treatment.

Liver Fibrosis Score – these PA requirements are put in place as another “cost containment” measure and require that patients seeking DAA drugs to cure their HCV have an advanced case of the disease. Fibrosis Scores (F-Scores) range between 0 and 4, with 0 showing no signs of liver fibrosis (scarring of the liver), and 4 showing the presence of liver cirrhosis.

This requirement is used both in state Medicaid, and DOC programs as a way of rationing care, the underlying belief being that, because HCV is traditionally a slow-progressing virus, treatment can wait. Both Medicaid, and DOCs sell this as “prioritizing the sickest patients, first.” In reality, these policies amount to, “Don’t treat until the patient is sick enough.”

Despite living in one of the richest nations in the world, the U.S. continues to artificially prolong a public health crisis of epidemic proportions, and one that, when left untreated, leads to numerous comorbidities, both hepatic (liver-related), and extrahepatic. It’s time for the U.S. to stop denying treatment. Period.

References:

  • Grebely, J., Prins, M., Hellard, M., Cox, A. L., Osburn, W. O., Lauer, G., Page, K., Lloyd, A. R., Dore, G. J., & International Collaboration of Incident HIV and Hepatitis C in Injecting Cohorts (InC3) (2012). Hepatitis C virus clearance, reinfection, and persistence, with insights from studies of injecting drug users: towards a vaccine. The Lancet. Infectious diseases, 12(5), 408–414. https://doi.org/10.1016/S1473-3099(12)70010-5

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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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Maine Settles Correctional Hepatitis Case

By: Marcus J. Hopkins, Policy Consultant

The Maine Department of Corrections (MDOC) has agreed to expand curative treatment for Hepatitis C (HCV) to all inmates in its state prisons as part of a settlement agreement (Gray, 2020). This agreement will expand access to HCV Direct-Acting Antivirals (DAAs) to all inmates over a period of four years.

Maine Department of Corrections

This settlement is one of several over the past five years to reach a similar outcome, including cases in California, Kansas, and Massachusetts. Other cases, however, have faced considerable setbacks (Hopkins, 2020): cases in Florida, Kentucky, Illinois, and Tennessee have all been either overturned, had their class certification revoked, or the courts have found that the actions of the DOC did not raise to the level of “Deliberate Indifference” – the requirement set forth in Estelle v Gamble that actions must occur as a result of conscious or reckless disregard of the consequences.

Prisoners in the United States are, in fact, the only citizens to whom healthcare is a guaranteed right under the 8th Amendment’s Cruel and Unusual Punishment clause (Estelle v Gamble). Despite this guarantee, state jails, prisons, and detention centers, particularly those in rural areas or in largely rural states, are often woefully under-resourced in terms of funding, staffing, and access to medical personnel and/or providers.

In most cases brought on the legal principle set forth in Estelle v Gamble are met with defensive arguments from DOCs that treatment is “too expensive.” To be fair, the cost of medications for correctional facilities is higher than other providers of care, because correctional facilities are not, themselves, allowed to enter pricing negotiations or to receive rebates for drugs. That said, a few workarounds exist, including taking inmates whose Medicaid status has been suspended to an outside treatment facility where their status can be reactivated (meaning that Medicaid pays for treatment), and having states combine correctional pharmaceutical purchasing into a single purchasing body that negotiates for drugs for both Medicaid and correctional facilities. The latter is, by far, the easier path, as it doesn’t require the moving of inmates into and out of the correctional facility.

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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HHS Announces Dangerous Draft Regulations for Importing Drugs from Canada

By: Shabbir Safdar, Executive Director of the Partnership for Safe Medicines

Citizens of the United States and Canada should be outraged that the Trump Administration has prioritized politics over their own health and safety. There’s only one logical explanation why the Administration chose this week to greenlight a flawed and dangerous policy that Republican and Democratic Administrations alike have rejected – political distraction. The process has been mishandled from day one, which stands in stark contrast to the time and effort that other administrations have put into this issue.

Source: Partnership for Safe Medicines

It is well-documented that the Canadian drug supply is not nearly large enough to meet the demand of U.S. patients. So even with a fraction of U.S. drugs coming from Canada, life-threatening shortages would become the reality there within mere months.

We’ve seen time and again that gaps in supply are filled by dangerous counterfeits that can end up in the hands of patients on both sides of the border – a risk that’s dramatically exacerbated by this importation policy.

Perhaps most frustrating is that there is no guarantee patients will get financial relief at the pharmacy counter. Multiple states, including Illinois, Minnesota, and Maine, have attempted to implement drug importation and failed. These schemes have never been able to sustain economic savings that offset their costs, and all of them have had safety lapses.

This is far worse than a lump of coal in one’s stocking. It’s more like a ticking time bomb that will inevitably result in dire consequences for Americans and Canadians alike. As we assess the proposed rule and draft guidance issued by the U.S. Department of Health and Human Services today, we will continue to vigorously defend the integrity of our drug supply and work to ensure that health and safety always come first.

Watch our 22 minute webinar outlining the problems with Canadian drug importation (Archived from Dec 17).

Read our statement on “Ukrainian Pair Pleads Guilty To Importing And Selling Fake Cancer And Hepatitis C Drugs” (Archived from July 22).

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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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Missing the Linkage Between Rapid Testing and Treatment

By: Marcus J. Hopkins, Policy Consultant

When I lived in Los Angeles, I competed for and won a bar’s “leather” title – Mr. Pistons Leather 2010 – and immediately set out putting together fundraising events for the Long Beach AIDS Foundation (then-led by the inimitable Garry Bowie, who passed, this year, from COVID-19). One of the first events I hosted – Geared for Life – was supposed to have a Rapid HIV testing component, where bar patrons would come, get tested, find out their result, and……

……

That was where my plan ended.

It wasn’t because I didn’t know what to do, next; it was because I had just moved to Long Beach literally two weeks before the contest and didn’t know anything about the testing and/or treatment landscape in Long Beach. When I started seeking treatment, myself, and trying to find physicians, Ryan White coordinators, et cetera, I didn’t even know that, at the time, Long Beach didn’t have one, and I had to go into downtown Los Angeles to some AIDS Healthcare Foundation building, apply for and be denied Medi-Cal, and then, have an emergency application pushed through for approval…and then, ended up with a doctor in Torrance (Harbor-UCLA Medical Center), which was a rabbit warren of out-buildings and hospitals, and…it was a lot.

Linkages to care

Photo Source: Slideshare

Now, that I’m working with the Community Education Group (CEG), here in West Virginia, to expand access to Rapid HIV and Hepatitis C (HCV) testing, I actually understand the “Linkage to Care” component that my event proposal was missing. It’s not enough to just test someone for HIV or HCV, give them the result, and leave them holding the emotional bag and onus for making their next appointment; you must link that person to the next step(s) in the process: a confirmatory test; a handoff to another provider to set up their next appointment; setting the patient up with a caseworker.

New research out of the Boston Medical Center (BMC) found that, of the 200 participants selected for this research 48% tested positive for HCV and 0.5 for HIV. The problem comes because, of those who tested positive, only 6% of those patients were successfully linked into care (Assoumou, Paniagua, Lina, Wang, Samet, Hall, White, & Beckwith, 2020).

This issue is compounded by the fact that all of these participants self-reported a history of drug use – currently the single greatest contributor to new Viral Hepatitis infections in the United States across Hepatitis A, B, and C (Hopkins, 2020).

What makes all of this worse, for an advocacy perspective, is that Boston – and, indeed, virtually all of Massachusetts, is not a state lacking in qualified physicians or linkages to care, and yet, these patients were not linked to care, in one of the states with the best healthcare systems in the nation. Were this Alabama, Wyoming, or West Virginia, where there exists a dearth of linkages to be made, these numbers, while still unacceptable, would not be so shocking.

For those who are co-infected with HIV and HCV, recent research indicates that, while people living with HIV fare no worse than their HIV-negative counterparts when it comes to liver disease complications and liver-related death after being treated for HCV, but are likelier to die of other causes, including a three-times-higher risk of developing other types of non-liver cancers (Highleyman, 2020).

When you add in SUD as a factor, People Who Use Drugs are likelier than the general population to develop more severe issues as a result of their bodies’ inability to effectively fight illnesses, as well as to contract comorbid infectious diseases, depending upon their method of drug use.

One of the most important things we can do is break down the silos between HIV, SUD, and Viral Hepatitis testing, treatment, and services, including linkages to care. SUD providers must be willing to test and linkage their patients successfully into HIV and Viral Hepatitis care and treatment, just as HIV and Viral Hepatitis organizations and providers must successfully link their patients into SUD treatment and therapy, if needed.

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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CANN Presents 5th Annual National Monitoring Report on HIV/HCV Co-Infection

By: Marcus J. Hopkins, Policy Consultant

The Community Access National Network (CANN) joined forced with HealthHIV and HealthHCV to present its 5th Annual National Monitoring Report on HIV/HCV Co-Infection on Thursday, September 10th, 2020.

The National Monitoring Report was presented as part of HealthHIV’s annual SYNChronicity conference, which was held virtually as a result of the COVID-19 pandemic. The session was prerecorded with CANN’s Project Director and HEAL Blogger, Marcus J. Hopkins, and co-panelist A. Toni Young, Founder and Executive Director of the Community Education Group (CEG) based out of Shepherdstown, WV.

Findings:

Marcus presented on the state of Hepatitis C (HCV) Direct-Acting Antiviral (DAA) coverage across state Ryan White AIDS Drug Assistance Programs (ADAPs) and state Medicaid programs:

  • Only 8 state ADAP programs offer no coverage for HCV DAAs
    • Of those, Alaska and South Carolina offer coverage for older regimens (ribavirin and pegylated-interferon)
    • Six states – ID, KS, KY, OH, UT, & VT – offer no HCV treatment coverage, whatsoever
  • Every state Medicaid program currently offers coverage for at least one pangenotypic HCV DAA
    • There is almost no information that we have been able to find regarding the U.S. Territories (e.g. – American Samoa, Federated States of Micronesia, U.S. Virgin Islands, et cetera). Funding for Territorial Medicaid programs is done through block granting appropriated through Congress, meaning that the funds are both finite, and limited.

Marcus also presented on a troubling pattern related to Viral Hepatitis (VH) infection rates:

  • Five states – IN, KY, OH, TN, & WV – share a disproportionate burden of VH infection rates, across Hepatitis A (HAV), Hepatitis B (HBV), and HCV (Hopkins, 2020a)
    • HAV:
      • The national rate of HAV (per 100,000) in 2018 was 3.8. The states with the highest rates of reported acute HAV cases were:
        • West Virginia – 124.4
        • Kentucky – 79.7
        • Indiana & Ohio – 14.4
        • Tennessee – 9.7
    • HBV:
      • The national rate of HBV (per 100,000) in 2018 was 1.0. The states with the highest rates of Acute HBV were:
        • West Virginia – 7.3
        • Kentucky – 5.8
        • Maine – 3.9
        • Florida – 2.9
        • Tennessee – 2.8
    • HCV:
      • The national rate of HCV (per 100,000) in 2018 was 1.2. The states with the highest rates of Acute HCV were:
        • Indiana – 4.0
        • West Virginia – 3.9
        • Utah & Wyoming – 3.8
        • Kentucky – 3.7
        • Ohio – 2.4
    • IN, KY, OH, TN, & WV appear frequently within the Top Ten rates of infection across HAV, HBV, and HCV
      • Each state has a rate of Drug Overdose Deaths well above the national rate of 20.7
      • Each state lags in HIV and Viral Hepatitis testing in rural parts of the state – the areas where Injection Drug Use is highly prevalent
      • While some of these states have both federal, and state resources dedicated to addressing these issues, those funds are limited and insufficient to meet the need

After Marcus’ presentation, he was joined by A. Toni Young for an at-times-lively (and certainly frank) panel discussion about how COVID-19 has impacted the delivery of testing, treatment, and other services to patients living with HCV (as well as HIV and Substance Use Disorder – SUD).

Toni spoke about CEG’s work in West Virginia, where the organization is focused on to deconstructing the administrative, service delivery, and advocacy silos that limit testing, treatment, and support across HIV, SUD, and Viral Hepatitis programs by increasing awareness, education, and building linkage to care networks.

Disease state silo-ing occurs when service providers, administrators, governments, and advocacy organizations focus their efforts solely on a single disease state (e.g. – HCV) without addressing the fact that a single patient (e.g. – People Who Use/Inject Drugs – PWUD/PWID, respectively) is likely to be impacted by one or more comorbid conditions.

Using that example, in the state of West Virginia, the patient seeking treatment for SUD who partakes in Injection Drug Use (IDU) is very likely to have contracted one or more types of Viral Hepatitis and/or HIV. In 2019, alone, 62.3% of all new reported HIV infections in the state of West Virginia listed IDU as a primary risk factor (West Virginia Office of Epidemiology & Prevention Services, 2020).

However, when that patient goes to seek treatment for SUD, many providers in the state either do not offer testing for HIV, or do so using an Opt-In method of delivery, which is shown to result in fewer patients consenting to testing. Even when SUD patients are tested for HIV and/or Viral Hepatitis, if they receive a positive test result, whether or not those patients are linked immediately into care and treatment is uncertain, at best, and non-existent, at worst.

In response to this, CEG has recently formed the West Virginia Statewide Stakeholder Coalition (WVSSC). The first meeting of the WVSSC, held on September 1st, 2020, brought together 65 individuals and organizations including state government and public health officials, healthcare providers, national organizations, school board officials, Community-Based Organizations, and others from across West Virginia.

The WVSSC will hold meetings on the second Monday of every month at 2:00 PM Eastern, and those interested in joining the WCSSC may do so by filling out the registration form at the following address: https://form.jotform.com/202586193014048.

Toni also discussed the formation of the Rural Health Service Providers Network, a new national Network formed in collaboration with TruEvolution, Inc. (Riverside, CA) in response to the COVID-19 pandemic. To learn more about the RHSPN, you can visit their website (here) and/or sign on to their national advocacy efforts by filling out the sign-on form at the following address: https://form.jotform.com/202586199636064.

Download the 5th Annual National Monitoring Report on HIV/HCV Co-Infection at https://www.tiicann.org/urls/SYNC-2020-Virtual_HIV-HCV_Co-Infection_Watch_2020_Monitoring_Report-2.pptx.

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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