Viral Hepatitis Awareness Continues to Lag in United States

By: Marcus J. Hopkins, Policy Consultant

HEAL Blog (Hepatitis, Education, Advocacy, & Leadership) has been in publication since October of 2013, and in that time, we have striven to provide evidence-, research-, and patient-based news, data, and treatment information in an effort to foster the growth of awareness of primarily Hepatitis C (HCV), but also other strains of Viral Hepatitis (VH), including Hepatitis A (HAV) and Hepatitis B (HBV).

As we draw nearer to our sixth year in publication, there are times when I, as an advocate, am achieving that goal. Are my friends and family better educated about VH? Demonstrably, yes. Are the greater HIV/AIDS advocacy and activism communities better aware about VH and the role it plays in the lives of People Living With HIV/AIDS (PLWHA) as a result of my efforts? I would argue that, yes, that is the case. Is my local community, here in Morgantown, WV, better educated about VH as a result of my efforts? That answer is less clear.

Disease Awareness

Photo Source: Medivisual Health

In fact, recent research published in Clinical Gastroenterology and Hepatology indicates that American citizens are largely unaware of VH, particularly HBV and HCV. According to the study of 14,745 participants (68 of whom had HBV and 211 had HCV) only 32% of those with HBV were aware of their infection and only 49% of those with HCV were aware of their infection (Zhou & Terrault, 2019). From these results, the authors have estimated that fewer than 50% of U.S. adults with HBV or HCV are aware of their infection (Zhou & Terrault).

More than just being unaware of their infections, the research also indicated which factors were associated with greater awareness:

For HBV, those who were U.S. citizens, had attained higher education, and those with abnormal levels of alanine aminotransferase (an enzyme found primarily in the liver and kidney) were likelier to be aware of their HBV infection;

For HCV, being non-Hispanic, having income above the poverty line, being unmarried, and having a history of Injection Drug Use (IDU) were factors associated with greater awareness of their HCV infection.

These factors, particularly those associated with HCV, are disturbing, particularly because part of the overall VH advocacy community’s goal was to help educate hard-to-reach/hard-to-treat populations – the poor and minorities, specifically. Perhaps the only bright-ish spot within these data is that IDU was a factor in greater awareness of HCV, so…at least our efforts are reaching “A” community…?

Advocates and activists have, for years, been calling for greater provider education and screening efforts, particularly in areas where underserved, under-recognized, and at-risk communities are likely to receive treatment. We have called for expanded screening and testing for HBV and HCV in every healthcare setting, from private practices and hospitals, to clinics and incarceration settings. And yet, those efforts, particularly those which are not backed by costly litigation, seem to repeatedly fall upon deaf legislative ears, despite mounds of evidence being heaped upon elected and appointed officials indicating that we have a growing epidemic.

And then, I think back to my days in HIV advocacy. Much of the battle for combatting the spread of HIV has, for the last nearly-forty years, been a massive effort to spread awareness and expand testing. Current statistics from the Centers for Disease Control and Prevention (CDC) indicate that, in 2016, an estimated 1.1 million people in the U.S. had HIV, and of those, 14% (1 in 7) were unaware that they were infected (CDC, 2019). That percentage, back in the 1980s and 90s, was exponentially higher, despite efforts to increase awareness. It took nearly three decades of advocacy and activism – and countless lives lost in the process – to have a demonstrable impact.

What frustrates me, however, is that, as opposed to the 1980s and most of the 90s, access to the Internet is no longer severely limited; social media platforms now exist; we have almost the entirety of the planet’s history, research, and data literally at our fingertips. And yet, it is almost as difficult, now, as it was thirty years ago to disseminate medically accurate information, statistics, and health risks to the American populace.

Back in the 1990s, when HIV education campaigns were really ramping up into full-gear, combating rumors about the disease involved addressing the spread of word-of-mouth and Right-Wing fear mongering reports. Now, there are entire organizations dedicated to spreading misleading, misunderstood, or outright false information about HIV on the Internet, and their reach is broader than ever.

Numerous data indicate that Americans, in particular among international citizenships in similarly wealthy nations, largely lack understanding of basic scientific facts and the scientific process more broadly (Scheufele & Krause, 2019). As a nation, our appalling lack of understanding of basic science – which includes health-related scientific information – greatly hampers the ability of scientists, educators, the government, and advocates to impress upon our citizens the nature, severity, or risks related to several issues, from climate change to diet fads. Worse, still: further research indicates that Americans not only believe that our citizens don’t understand science, but that they are also concerned this lack of understanding is leading to disastrous consequences.

It is becoming increasingly difficult to combat misinformation, disinformation, and conspiracy theories that originate online, particularly when we have elected officials who not only parrot and spread these falsehoods, but revel in their own ignorance – “You may be a scientist and an expert in your field, but you don’t know what you’re talking about, fella!” Even the occupant in our White House frequently bloviates about how neither scientists, nor researchers, nor educators, nor economists, nor military generals know what they’re doing, and yet, his base of supporters continue to not only support him, but agree with those accusations.

So, how does all of this impact awareness of VH?

Simply put, Americans have become increasingly distrustful of authority figures (in this case, scientists, educators, and doctors, and in no small part as a result of a decades-long campaign from certain political pundits and legislators to discredit them). In addition, physicians, nurses, and state and local governments have largely failed to do their due diligence when it comes to informing patients and citizens about VH. All of this is complicated by a lack of resources, both human, and financial, allocated to increasing awareness.

It’s going to be a long fight, and it’s going to get worse, before things get better. We are going to lose a lot of lives to VH as a result of too lax testing protocols, a lack of epidemiological disease reporting and data, and a failure to direct adequate funding to these efforts. Hopefully, in the end, we’ll have something to show for it.

References:

  • Centers for Disease Control and Prevention. (2019, April 12). Basic Statistics. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of HIV/AIDS Prevention: HIV/AIDS: HIV Basic. Retrieved from: https://www.cdc.gov/hiv/basics/statistics.html
  • Scheufele, D.A. & Krause, N.M. (2019, April 16). Science audiences, misinformation, and fake news. Proceedings of the National Academy of Sciences of the United States of America 116(16), 7662-7668. DOI: https://doi.org/10.1073/pnas.1805871115
  • Zhou, K. & Terrault, N.A. (2019, June 04). Gaps in Viral Hepatitis Awareness in the United States in a Population-based Study. Clinical Gastroenterology and Hepatology. DOI: https://doi.org/10.1016/j.cgh.2019.05.047

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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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Patients Still Face Extrahepatic Risks After HCV Cure

By: Marcus J. Hopkins, Policy Consultant

Since the 2013 release of Gilead’s Sovaldi (sofosbuvir) and Janssen’s Olysio (simeprevir), Hepatitis C (HCV) has become increasingly easier to treat and cure by achieving what is known as Sustained Virologic Response (SVR12 or SVR24, meaning that the Hepatitis C Virus is undetectable for twelve or twenty-four weeks, respectively). Since that time, when only two Direct Acting Antivirals (DAAs) were available, the market has grown significantly, with a total of eight brand name drugs and two authorized generic drugs available as treatment options. Moreover, as the number of available treatments has increased, so too has the length of treatment decreased for many patients, from the initially recommended twelve-week regimens, down to eight-week regimens for a handful of drugs, resulting in higher medication adherence and completion in patients.

This increased tolerability and adherence has meant that doctors and state and federal Departments of Health have been likelier to treat earlier and to reduce or remove barriers to treatment that required patients to have a more advanced stage of the disease (measured by liver fibrosis scores of F0 to F4, with F4 being the most advanced stage) or to complete other prerequisite actions, such as mandated sobriety, abstinence, and drug and alcohol treatment programs, prior to treatment. Advocates and activists, including myself, have long argued that allowing HCV to progress to such a severe stage greatly increases the risk of patients developing hepatic or extrahepatic comorbidities (additional conditions originating inside or outside of the liver, respectively), each of which makes treating the patient, as opposed to just the disease, more difficult. The earlier patients are treated, the less likely they are to develop these comorbidities.

Gastroenterology Journal

Photo Source: Gastroenterology Journal

New evidence published in Gastroenterology has found that, while liver-related mortality among patients with HCV infection decreased from 2014-2017, cause-specific mortality from extrahepatic cancers increased as a result of immune dysregulation – an immune response that is not properly controlled or restrained (Swift, 2019). The authors of the study write:

If our findings are reproduced, then surveillance programs and forecasting models will need re-evaluation and revision with a focus on an ongoing need for risk-assessment and risk factor modification for extrahepatic cancer, cardiovascular disease, and diabetes in individuals with HCV infection following treatment with DAA agents (Kim et al, 2019).

Essentially, once patients have been successfully cured of HCV, additional monitoring is necessary to ensure that any additional extrahepatic comorbidities that may develop are caught in time to reduce the likelihood of mortality.

These findings, while less than encouraging, do not mean that early treatment strategies should be abandoned or reconsidered; instead, they allow us the opportunity to better treat patients as a whole, rather than simply focusing on their HCV infection in isolation.

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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Reaching HCV Co-Infection Elimination Through Ryan White And ADAP

By: Marcus J. Hopkins, Policy Consultant

The O’Neill Institute for National & Global Health Law recently released a fantastic issue brief entitled, “Eliminating Hepatitis C among People Living with HIV in the United States: Leveraging the Ryan White HIV/AIDS Program to Move Us Forward,” in which authors Sonia Canzater and Jeffrey S. Crowley “…explain how the path to systematically eliminating [Hepatitis C] can be achieved” (Marulanda, 2019).

Leveraging the Ryan White HIV/AIDS Program to Move Us Forward

The brief lays out four primary priorities for achieving elimination of Hepatitis C (HCV):

  • Comprehensive efforts to overcome financial, clinical, and other barriers to treatment;
  • Better metrics for tracking progress toward elimination;
  • Increased emphasis on re-screening key populations;
  • Strengthened planning and commitment to HCV elimination in states, communities, and clinics (Canzater & Crowley, 2019).

The Ryan White Program, Canzater and Crowley illustrate, is one of the few government programs that is specifically designed to treat a singular population: people living with HIV. As such, state Ryan White programs are perfectly positioned to help states “…innovate in building data and monitoring systems that enable medical and non-medical providers, health plans, health departments, and others to work together to improve patient outcomes” (Canzater & Crowley). In fact, they argue, that is one of the program’s essential roles…as it relates to HIV monitoring.

This role can and should be used, they argue, to help states, the Centers for Disease Control and Prevention (CDC), and the Health Resources and Services Administration (HRSA – the Federal agency that oversees the Ryan White HIV/AIDS Program) to develop new metrics for monitoring HCV in the People Living with HIV/AIDS (PLWHA) population. This can be done by reexamining the existing metrics and reporting requirements currently faced by providers (e.g. – CD4 monitoring, risk behaviors for HIV infection, risk behaviors for STD/STI infections, regularity of screening/testing, et cetera), determining which metrics are still useful in the context of modern healthcare and HIV surveillance, eliminating those deemed less impactful, and developing new streamlined requirements that include HCV reporting.

In the advocacy and activism roles I play, one of my biggest frustrations with HCV monitoring is the dearth of available data. Underinvestment in HCV prevention and monitoring at the CDC and state-level epidemiology and health departments has created an environment where accurately reporting new and Chronic HCV infections is essentially a “guesstimate.” Less than 25% of U.S. states have received Federal funds for the purposes of HCV surveillance, and even in those states, reporting varies widely from state to state. So onerous is the problem that the CDC, which usually releases its annual Surveillance Report in April, May, or early-June, has failed to issue the 2017 Surveillance (as of June 27th, 2019) upon which states and advocates rely in order to determine action plans and policy proposals.

Whenever I have mentioned adding HCV reporting to Ryan White directors, I have been met with either tepid agreement, or outright hostility. One former state director, when the Community Access National Network (CANN) first began our HIV/HCV Co-Infection Watch in 2015, told me frankly:

Most of my work, each quarter, goes to tracking the various reporting metrics we are required to report. The very last thing I, or any other person at Ryan White, need is yet anotherreporting requirement.

As an advocate, this frustrates me to no end, not because I think that she is wrong; but, because I think that HCV reporting and monitoring within HIV patients, and in the Ryan White Program, specifically, is desperately needed. In fact, this director – who has since moved on to another position – later spoke with me and agreed that it issomething that is a serious health concern, particularly given the grim guesstimates regarding HIV/HCV co-infection (which can range between anywhere from 30% to 50% or greater rates of co-infection). So, it isn’t that people don’t see the need for this reporting requirement; it’s that the number of existing reporting requirements demanded of both providers and Ryan White Programs is so staggering, adding even the handful of reporting metrics needed to monitor HCV would be a huge ask.

This is where Canzater and Crowley’s suggestion comes into play. We, in the HIV world, have become increasingly entrenched in our ways. While changes in advertising, education, treatment, and thinking are always welcomed, the types and ways in which we capture and utilize HIV data hasn’t really been rethought in over a decade. In fact, rather than revise what metrics are needed, we have developed a tendency to simply add on to what is required, leaving us with a laundry list that would make a dry cleaner cry. We’ve done this using the line of thought that more information is better than too little information, and in so doing, we have created a Frankenstein’s Monster of reporting requirements that gives us more information than is currently useful given the host of changes we have welcomed that have changed the face of the epidemic.

Take the time to read the O’Neill Institute’s fantastic issue brief, which you can find here:

Eliminating Hepatitis C among People Living with HIV in the United States: Leveraging the Ryan White HIV/AIDS Program to Move Us Forward

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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Preventing Vertical Transmission Of Hepatitis C

By: Marcus J. Hopkins, Policy Consultant

An article published in the Canadian Medical Association Journal (CMAJ) recommends universal screening for Hepatitis C (HCV) of pregnant women in Canada, as they do for Hepatitis B (HBV) and HIV, in order to prevent vertical transmission of the virus from mother to fetus (Elwood, Sauve, & Pick, 2019). Vertical transmission of HCV is considerably low – 5%-6% in HCV-monoinfected women to 10% in HIV/HCV-co-infected women (Elwood).

CMAJ

Photo Source: CMAJ

This may be a commentary on my perception of the Canadian healthcare system (which is universal), but I think that this is an excellent step forward for Canadian expectant mothers, particularly considering that rates of new HCV infections are increasing, and that HCV is now a curable condition.

And then, there’s the U.S. healthcare system.

In 2018, Kentucky became the first U.S. state to pass legislation requiring all pregnant women to be tested for HCV, HCV advocates in the U.S. lauded Kentucky for taking this very important step to reduce vertical transmission in the state that has 5th-highest rate of new HCV infections in the nation (Centers for Disease Control and Prevention, 2018).

But, the issue doesn’t begin and end with HCV testing.

When patients are tested for virtually any infectious disease, various data are collected, one of which are “Risk Factors.” For younger Americans, the majority of people under the age of 55 who contract HCV list “Injection Drug Use” as the primary risk factor. Many patients are reluctant to report this as a risk factor (which they should, because we – meaning activists, advocates, and healthcare professionals – need these data to demonstrate why Harm Reduction measures that include Syringe Services Programs work to reduce HCV infections amongst People Who Inject Drugs (PWIDs), and if they’re pregnant and living in Kentucky, they should be reluctant.

In 2019, Kentucky also passed legislation that expands the definition of “Child Abuse” to include neonatal abstinence syndrome (Landis, 2019). The legislature redefined this in response to the exponential growth of opioid-dependent infants born in the state – from 46 babies in 2001 to 1,115 in 2016 (Landis). The thinking behind this expanded definition was that, if expectant mothers can be charged with child abuse, they will be less likely to misuse or abuse opioid drugs. Whether that will be the case remains to be seen, but one would be hard-pressed to find voters unfamiliar with either how addiction works, or how well abuse-deterrent legislative efforts have fared in the past (did Prohibition work? No) who are opposed to this new definition. When it comes to pregnancy, voters (and people, in general) tend to be pretty firmly against any and all substance use and tend to take a punitive approach to dealing with substance use issues when pregnancy is involved.

Hepatitis C

Photo Source: ANI

For pregnant women in Kentucky, however, this second legislative effort has the potential to expose those women to legal jeopardy as a result of complying with the mandated HCV testing. Suppose that a pregnant woman’s test returns positive for HCV and they report that their main risk factor is IDU. This means that, because medical providers are mandated reporters, they are required by law to report any suspicion of child abuse or neglect to the relevant authorities. It is in this circumstance that the doctor/patient confidentiality provisions by which healthcare providers are generally bound may not apply under the new definition of “child abuse.”

My view, then, is that, at least in Canada and in other nations where substance abuse disorders receive treatment, rather than immediate imprisonment, universal testing in pregnant women is an excellent step to prevent vertical transmission. In fact, it would be a great step in the U.S., as well…except that 23 states and the District of Columbia consider substance use during pregnancy to be child abuse under child-welfare statues, and 25 states and the District of Columbia require health care professionals to report suspected prenatal drug abuse (Guttmacher Institute, 2019), meaning that their positive HCV test result could end up creating more trouble for them than the disease, itself.

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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Hepatitis C Direct Acting Antivirals Show Low Risk Of Adverse Events

By: Marcus J. Hopkins, Policy Consultant

A review of outcomes from a retrospective cohort of 33,808 patients who received treatment for their Chronic Hepatitis C (HCV) infection with Direct Acting Antivirals (DAAs) did not experience higher rates of adverse health events across any of the categories considered, including hepatic, renal, cardiovascular, and/or oncologic events (McGlynn et al, 2019). These findings suggest that HCV patients who undergo treatment with DAAs experience fewer HCV-related adverse health events compared to patients who did not receive treatment.

Direct Acting Antivirals (DAAs)

Photo Source: Prof. Ed Gane of the New Zealand Liver Transplant Unit

The researchers warn, however, that these findings should not serve as evidence that DAA drug therapies have a protective effect against adverse events, noting the possibility of selection bias – the selection of groups, data, or individuals in such a way that proper randomization is not achieved, thereby ensuring that the sample obtained is not representative of the population intended to be analyzed – in the study. Essentially, we should not presume that DAA treatment will prevent co-morbidities from developing or manifesting during or after treatment.

Co-morbidities associated with Chronic HCV infections can include liver cirrhosis, liver cancer, depression, coronary artery disease, and chronic kidney disease, to name a few. The longer HCV goes untreated in the body, the more likely patients become to develop both hepatic, and extra-hepatic co-morbid conditions, none of which are easy or cheap to treat. As such, advocates and activists have been consistently arguing that early treatment with DAAs, regardless of the short-term expenditures associated with the high cost of HCV treatment, will lead to long-term savings, because these co-morbid conditions may be averted.

In her comments on the research referenced in this blog, Dr. Lauren A. Beste reminds us that there are potential risks associated with DAA treatments, including potential reactivation of Hepatitis B and several critical drug/drug contraindications (Beste, 2019). She also notes that rates of adverse events in large, real-world populations has been largely overlooked in terms of data made available. This research aims to bridge that data gap. She also states that the next major hurdle to overcome in HCV treatment is, unsurprisingly, price.

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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New Study Finds Twelve-Week Course More Effective for HIV/HCV Co-Infection

By: Marcus J. Hopkins, Policy Consultant

A new study published in the Journal of Infection found that patients co-infected with HIV and Hepatitis C (HCV) are more likely to achieve Sustained Virologic Response (SVR12 – AKA – “cure”) when receiving twelve weeks of treatment using Gilead’s Harvoni (sofosbuvir/ledipasvir), than the recently approved eight-week treatment regimen (Corma-Gómez et al., 2019). Co-infected patients were likelier to relapse when treated for eight-weeks, which necessitates the need for retreatment.

For those unfamiliar with treatment lengths, prior to the 2013 release of HCV Direct-Acting Antivirals, successful treatment and achievement of HCV SVR12 could take up to a year or longer using the pre-DAA pegylated-interferon-based treatment regimens. With the release of Gilead’s Sovaldi (sofosbuvir) and Janssen’s now-defunct Olysio (simeprevir), the cure for HCV became far easier to tolerate and treatment length was, for most patients, reduced to a mere twelve weeks. It wasn’t until 2017 that the U.S. Food and Drug Administration (FDA) approved AbbVie’s Mavyret (glecaprevir/pibrentasvir) as the first eight-week regimen (Young, 2017). Following Mavyret’s approval, other manufacturers began receiving approvals for eight-week regimens, as well.

Why is HIV/HCV Coinfection Important?

Photo Source: Quest Diagnostics

This shortening of treatment duration has had a couple of positive impacts for both patients and payors – shorter treatment durations tend to increase regimen adherence (thereby decreasing treatment abandonment) and the shorter durations also results in lower treatment costs per patient. Obviously, there are some patients who may fail to achieve SVR12 using either an eight- or twelve-week regimen, and certain patients with decompensated liver cirrhosis (or other issues) may require longer treatment durations. For patients who rely upon publicly-funded insurance programs (such as Medicaid or Ryan White), the lower costs associated with shorter regimens for general HCV patients will free up funds to cover longer treatment durations for those who require them.

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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More Appalachian Outbreak Woes in Northeastern Tennessee

By: Marcus J. Hopkins, Policy Consultant

The Tri-Cities Region of Northeastern Tennessee (NETN) is comprised of three smaller cities – Kingsport, TN, Johnson City, TN, and Bristol, TN/VA (the city straddles the state line between the two). It is a region with which I am intimately familiar, having graduated from Dobyns-Bennett High School (DBHS), in Kingsport, and attended East Tennessee State University (ETSU), in Johnson City. I’ve documented, before, both on HEAL Blog and over on the ADAP Advocacy Association’s (aaa+) blog about my experiences, both positive and negative, living in the region as an openly HIV-positive, adult gay male. I still keep in touch with one of my health communication mentors at ETSU, Dr. Kelly A. Dorgan, who helped to mold my advocacy approaches and writing to better communicate health information to underserved and disproportionately impacted populations, as well as my best-friend from high school who currently serves as a student counselor to students attending middle and high school.

Tri-Cities Region, Tennessee

From the latter, I have heard devastating anecdotes about children whose homelives have been fundamentally altered or destroyed by the opioid addiction epidemic plaguing the Appalachian Mountain Region (AMR). Another friend contacted me, last year, stating, with some sense of irony, that he was “…fat and hepatic,” and was desperate for assistance to get treatment for his Hepatitis C (HCV) infection in a state where Medicaid has not been expanded, health insurance plans are inadequate, and charity care options are sparse and overburdened. Yet another friend works for a local charity that provides infectious disease outreach, education, and testing to prisoners reentering the general population in the area; her reports are equally bleak.

If it sounds like I am painting a brutal picture of an otherwise gorgeous area of the country, it is not because I am being overly dramatic; hidden beneath the canopy of deciduous forests and rolling mountains teems a veritable hotbed of Injection Drug Use (IDU), poor access to healthcare services, and an Antebellum distrust of authority figures (e.g. – medical professionals, law enforcement, and government officials). This is an area of the country with a long history of landgrabs, surreptitious sterilization, and endemic poverty that has resulted in a fundamentally ingrained distrust of outsiders, particularly those from government agencies.

Along with the high levels of IDU, NETN has seen concomitant increases in new HCV and Hepatitis A (HAV) infections, though they have yet to see increases in new HIV infections, as of yet. In light of those increases, ETSU launched the Syringe Trade and Education Program (STEP) in 2018, where drug users can safely and legally trade used needles for sterile ones, obtain Naloxone – an opioid antagonist designed to rapidly reverse and opioid overdose, and potentially gain access to recovery services (WJHL, 2019).

Additionally, Dr. David Kirschke, the State Deputy Epidemiologist for the Tennessee Department of Health, said that the state has been monitoring the increase in new infections for roughly six years and have begun implementing mass Hepatitis A vaccination campaigns targeting groups for vaccination at homeless shelters, drug treatment clinics, and jails. Those campaigns, while helpful, have not yet stemmed the tide of new HAV infections, in no small part because the virus is very easily spread by way of poor hygiene and person-to-person contact.

While STEP is an excellent step (as it were) toward combating the spread of infectious disease within People Who Inject Drugs, area law enforcement are less than enthused about the program’s presence in the area, according to Dr. Sarah Melton, a professor of Pharmacy Practice at the Bill Gatton College of Pharmacy at ETSU:

“I think in most areas, we see pushback from law enforcement because they see that as enabling people to use the syringes and inject,” Melton said. “Really, they’re going to be using anyway, that’s the nature of addiction, so we want them to do so safely and decrease the transmission of diseases.

“What we know is that really in a hotbed of risk, so southwest Virginia, northeast Tennessee, we’re at a really high risk of an epidemic of HIV or Hepatitis C breaking out because of people using the syringes in close proximity to one another” (WJHL).

HEAL Blog will continue to monitor the situation in NETN and Southwestern 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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