By: Marcus J. Hopkins, Blogger
The National Academies of Sciences, Engineering, and Medicine and the National Academies Press (NAP) have released their latest report, Eliminating the Public Health Problem of Hepatitis B and C in the United States: Phase One Report, in which they detail the best, most likely, and least likely ways in which the U.S. can effectively combat the growing HCV (and HBV) epidemic(s). In their findings, they report many conclusions that we in the HCV advocacy community have known for much of this decade, and in so doing, lend credibility and quantifiable evidence that we can use to better arm ourselves against a recalcitrant, uncooperative, and undependable federal government.
For some reason, accomplishing anything in Washington takes what feels like forever. Any initiative, regardless of the size or importance, faces seemingly endless hurdles and red tape, and it always seems as if every single person and committee has to get their hands on something before it comes to any sort of vote…if it even gets through said committees to make it to the floor. Combine this with the fact that, even with one party controlling both the House and the Senate, no one can manage to get anything of national import accomplished, and it’s no wonder Americans have gotten angry and feel largely disgusted with Washington.
Outsiders – those who are neither familiar with, nor privy to the “way things work” in Washington – often find themselves baffled that seemingly common sense measures take forever to put in place, especially when it comes to matters of life and death. Furthermore, excited reports of “success” in the realm of healthcare-related efforts often leave those of us on the outside feeling a little pissed off as what seems like largely incremental changes are heralded as “momentous” and “great strides forward.” Many times, I’ve found myself wanting to respond with, “Umm…you literally just got someone to say, on the record, that HCV is a big problem, and that we should really think about addressing it. What the hell is the big deal?!” And I know I’m not alone, in this regard; people living with HIV and HCV frequently find themselves frustrated at the glacial pace and seemingly miniscule results of progress.
In reality, there are hundreds of people who work tirelessly around the clock to ensure that these “minor” changes occur, and even though it’s difficult to see when you’re in the thick of things (i.e. – living with the problem), all of these seemingly minor chinks add up to destroy the armored barriers that have long prevented the HCV community from gaining the equal footing it needs to be seriously addressed.
This report from NAP takes all of the various bits of data we’ve been collecting over the last two decades and puts them together in what amounts to a significant report that will prove instrumental in convincing some of the less recalcitrant members of Congress to begin supporting better legislative efforts to address a very life-threatening and expensive problem. Those legislators who have feigned horror at the cost of HCV DAA drugs are usually the first to join our fight, but this tool will allow us to present the myriad data points related to HCV – screening issues, data collection barriers, barriers to diagnosis and treatment, and economic burdens (both personal and state) – in the hopes that even those who view HCV as mainly the problem of drug addicts, the poor, and the unemployed to take the looming healthcare disaster seriously.
Some of the key findings of this report include:
- Injection Drug Users (IDUs) are driving the exponential increase in new HCV infections, and are more likely to transmit HCV than other patients
- IDUs are increasingly living in suburban and rural areas, rather than urban areas, and adapting Harm Reduction to less densely populated areas will be difficult
- IDUs are less likely to be tested for HCV or be captured in disease surveillance data
- Deliberate attention must be paid to the highest risk populations (lower-income Whites and Native Americans living in suburban, rural, and reservation areas) in order to effectively stop the rapid spread of HCV infections
- An element of passive racism – doctors being hesitant to prescribe opioid drugs to African Americans and Hispanic patients – has played a unique role in lessening the impact of HCV infection upon those populations
- The high cost of DAA drugs has driven private and public payers to largely restrict access to these drugs, requiring an unreasonable amount of hurdles and prerequisites from patients for treatment
- Half of people with Chronic HCV are undiagnosed
- Even though HCV is twice as common and has a higher mortality rate than HIV, far fewer resources are allocated to its prevention, testing, treatment, and research
- Even at current prices, DAA HCV drugs are cost-effective, as the long-term costs of HCV and HCV-related health issues will prove more expensive to treat; additionally, the benefits of treatment outweigh the cost
- Surveillance data routinely fails to capture and/or include IDU, indigent, and prison populations, the latter of which accounts for 1/3 of Chronic HCV cases in the U.S., which prison healthcare systems are neither equipped, nor funded to address
- HCV infection, much like HIV, carries with it a stigma, which serves as a barrier to treatment
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.