By: Marcus J. Hopkins, Blogger
The Hepatitis Policy Project (HPP), a project of the O’Neill Institute for National & Global Health Law at Georgetown Law in Washington, D.C., released in June 2017 their latest report, “Monitoring the Hepatitis C Epidemic in the United States: What Tools Are Needed to Achieve Elimination?” The report highlights five key recommendations that the institute believes need to be implemented in order to ensure the elimination of Hepatitis C (HCV) in the United States.
It is important to note that these recommendations fall in line with what HCV advocates and organizations have been stating for years: state and Federal governments are failing to adequately address the lack of concrete reporting data for the disease that kills more Americans each year than the total combined number of deaths from 60 other infectious diseases, including HIV, tuberculosis (TB), and pneumococcal disease (CDC, 2016). The primary reason for this failure on the part of all parties: financial resources – neither the Federal, nor state governments are allocating adequate funds in order to make mandatory the reporting of HCV infections in every state, and as a result, the Centers for Disease Control and Prevention (CDC) and other research and reporting bodies must rely on inaccurate, passive, and/or outdated data reporting that is simply inefficient and unacceptable.
HEAL Blog, in May 2017, wrote about this data issue when the CDC and Emory University revealed its Hepatitis monitoring tool, HepVu, that contains data that is seven years out of date (Hopkins, 2017). Our argument contends that seven-year-old data is an ineffective tool for helping lawmakers and government agencies to craft data-driven policies and regulations. If the data is not current within one or two years, policymakers have little use for it. The HPP report makes five key recommendations designed to eliminate these data collection issues:
- Expand and standardize reporting to the CDC: The CDC’s Department of Viral Hepatitis (DVH) is only now expanding funding efforts from 7 jurisdictions to 14 – an unacceptably (but expanded) low number. The DVH should work with Congressional appropriators to create a five-year plan to expand and build the capacity to conduct active surveillance to the great majority of states. This should include the development of a standardized reporting rubric that details the specific patient information that must be provided by clinicians and subsequently passed on to the states – a strategy that has been in place for HIV since the 1990s, and has helped to create more accurate data reporting and craft data-drive policies to address the epidemic. This will require more money.
- Utilize electronic medical records to collect data on HCV cases and the cure cascade: Modern medicine makes great use of technology, including the collection and retention of medical records; what is lacking is a system to centralize and analyze these data. Better use of electronic medical records information could improve the consistency, quality, and accuracy of case reports made by states by lessening the burden on providers and laboratories to report new cases to state health authorities that is required under the current scheme. The current requirement for providers and labs to le reports strains their already limited time and personnel resources, and often leads to incomplete reporting. This data could instead be pulled together by state epidemiologists using an integrated electronic medical records database, which would also provide matching metrics with cases, such as race, age, gender, sex, and progress of treatment.
- Fund epidemiological research using clinical data sets: Clinical care data are a largely untapped resource that relies on data that already exist. As such, greater efforts are needed to fund analyses of such data. This recommendation also suggests that several agencies across the Federal Health and Human Services department be directed to fund epidemiological research on HCV.
- Integrate improved monitoring of HCV with responses to the opioid epidemic: With most new cases of HCV being related to Injection Drug Use (IDU), largely driven by the nation’s out-of-control opioid addiction epidemic, it is imperative that we tie HCV prevention and treatment efforts to substance abuse prevention and treatment measures, elevating HCV as a signature component of the national response to opioid abuse.
- Establish and monitor HCV elimination plans across major U.S. health systems: The U.S. has several large established health systems – Medicaid, Medicare, the V.A., and various correctional systems. It is, therefore, imperative that we focus HCV elimination efforts on these major systems in order to adequately approach the elimination of HCV across all health systems. Starting with government-funded health systems allows for better monitoring of patients and patient outcomes.
The HPP report is an excellent document that outlines several real-world solutions that could (and should) be implemented across local, state, and Federal governments in order to achieve the elimination of HCV in the United States. Download the full report.
- Centers for Disease Control and Prevention. (2016, May 04). Hepatitis C Kills More Americans than Any Other Infectious Disease. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: Newsroom Home: Press Materials: CDC Newsroom Releases. Retrieved from: https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html
- Hopkins, M.J. (2017, May 01). Emory University and CDC Reveal HepVu. Washington, D.C.: Community Access National Network: HEAL Blog. Retrieved from: https://communityaccessnationalnetwork.wordpress.com/2017/05/01/emory-university-and-cdc-reveal-hepvu/
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.