Tag Archives: CDC

A Call for Accurate Disease Reporting

By: Marcus J. Hopkins, Policy Consultant

Every week, I submit to the Community Access National Network five or six potential topics to cover for HEAL Blog along with links from which to start my reporting. After they select my topic, I’ll go to the original source and research more, from there, trying to get various takes on the topic, verify the facts stated, and back up any assertions I make with evidence and citations.

Twice, this year, I have run into issues with reporting: the assertions the writers (and in some cases, state officials) make do not comport with the data they cite.

Centers for Disease Control and Prevention

The first was in January. A story appeared in my daily newsfeed stating:

Data from the Centers for Disease Control and Prevention released Wednesday showed Oklahoma had the highest rates of deaths from complications of the virus and of people living with hepatitis C infections, other than the District of Columbia (Wingerter, 2019).

Now, this struck me as odd, given that, when it comes to Hepatitis C (HCV) statistics, I tend to be very on top of things. So, I fired up a Google search: “CDC Hepatitis C Oklahoma”. I got a couple more hits linking me to similar stories on various news websites, all of which cited this same CDC report. Thinking I’d missed something, I went directly to the CDC website…and their Morbidity and Mortality Weekly Report (MMWR) website…and the National Institutes of Health (NIH) website, since they often get lumped together with the CDC. And what I found after an exhaustive search of all three sites was…

Nothing.

And believe me, I tried to find this supposedly recent report that supposedly bumped the state of Oklahoma’s rate of new HCV infections up from being tied for 13th-highest rate of new infections in 2016 (a rate of 0.8 per 100,000 – lower than the national rate of 1.0) up past a staggering 21 states (including states that had tied rates higher than Oklahoma in 2016) and above West Virginia’s rate of 5.1. Their rate of new infections would’ve had to increase by 4.4 points in order to beat out my home state.

An increase of new infections of that magnitude would most certainly have made the rounds within the numerous HCV newsgroups, searches, action committees, and advocacy councils from which I get approximately thirty E-mails a day.

And yet…nothing.

So, I did what any good researcher or reporter would do and contacted each of the writers whose stories cited this alleged report (without providing any links to the CDC’s Viral Hepatitis page or to the report they reference):

Good Evening:

My name is Marcus J. Hopkins, Project Director of the HIV/HCV Co-Infection Watch. I’m writing in regard to a story you reported on [date] in [publication]. I am attempting to find the report from the CDC that you cite in your article, but am having no luck finding this report on the CDC’s website, the MMWR website, or the NIH website. Could you please provide me with a link to this report, so that I can properly cite this in an article I’m working on related to this reporting of a massive increase in new HCV cases in Oklahoma.

I hope all is well, and that I hear from you, soon.

Sincerely,
Marcus J. Hopkins

That request was sent to a total of four different reporters, and was followed up by requesting the source via social media responses on their respective tweets linking to their articles. It is March 14th, as of this writing, and I have yet to receive a single response via any platform from any reporter.

The second instance occurred, today, when another article showed up in my newsfeed; this time, from California. The headline reads, “Upswing in New Cases of HIV, Hep C and STDs Prompts Call for Statewide Task Force” (Knight, 2019)

Again, I was confused by this reporting, because I am pretty on top of those data, as well. When last I checked, aside from a single-year uptick in new infections in 2014, rates of new infection have been on a relatively downward trend since 2010, in California (see chart):

CDC Chart on new HIV infections

(CDC, 2017)

Starting with a rate of new infections of 17.1 in 2010, that rate has decreased in all years except for 2014, when the rate jumped 1.2 points from 14.8 in 2013 to 16.0 in 2014. Since that year, once again, the rate of new infections has continued to decline, finishing at a rate of 15.2 in 2016 (CDC, 2017).

Moreover, this report also asserts that new HCV cases in California were up, as well; and, again, the data considered the gold standard – those provided by the CDC – do not back up this assertion. From 2012-2016, the rate of new Acute HCV infections in the state of California have remained consistent: 0.2 per 100,000 (CDC, 2018).

So, where is the disconnect between the data that are available, and what is being reported? Honestly, I cannot come up with a valid excuse for this kind of reporting. As an advocate for Viral Hepatitis and an activist and advocate for HIV, as well as someone whose job depends on accurate reporting, these kinds of oversights – willful or otherwise – frustrate me to no end. I work very hard, every week, to ensure that the data I report are accurate, and if I discover that I have misreported something or made an error, I go out of my way to ensure that I respond to those instances as quickly as possible.

Why is it important for reporters and researchers to do their due diligence and go the extra mile to back up their statements of fact? For this reason: the data we put forth are going to be used by people who either don’t have the skill, or the wherewithal to do their own due diligence. They’re going to be used by well-meaning activists and advocates when they go to elected and appointed officials and cited as facts. If and when those officials discover that the data being used to argue a point are incorrect, they immediately begin to disregard the efforts of those with whom they do not already agree on an issue.

Worse, still – repeated instances of poorly cited and sourced data are frequently used to discredit those who advocate for increased spending on infectious diseases. If we use incorrect data and do not immediately correct ourselves, we’re shooting ourselves in the collective foot. How are we going to convince officials who are on the fence about the need to legalize, establish, staff, and fund Syringe Services Programs to prevent the spread of HIV, Hepatitis B, and HCV amongst People Who Inject Drugs if we go to them was data that does not support our assertions?

The crux of the issue is this: it is owed to the American public (and, indeed, the world) to accurately report data and describe trends as they relate to infectious disease. When we erroneously report observed increases in new infection rates, only to be proven wrong, citizens and officials, alike, begin to accuse us of being hyperbolic; of being overly dramatic; of overplaying the risk. And the last thing that we need is for those people to be correct.

References:

__________

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.

 

Advertisements

Leave a comment

Filed under Uncategorized

Hepatitis C Prevalence Trends Highest in Western, Appalachian States

By: Marcus J. Hopkins, Policy Consultant

For much of HEAL Blog’s nearly six years, I have been banging the drum about Hepatitis C (HCV) infection rates in rural Appalachia so loudly that our neighbors have filed several noise complaints. Each year, around this time, both state Departments of Epidemiology and the Centers for Disease Control and Prevention (CDC) begin issuing the Acute HCV infection rates for the U.S. from two years prior (e.g. – in 2019, the figures for 2017 will be released), and between February and June, I spent much of my time trying to convince legislators, infectious disease advocates, HIV advocates, and local politicians about why it is vital to pay better attention to this disease.

State-Level Map Showing Impact of Hepatitis C Epidemic Across the U.S.

Photo Source: HepVu

For example, West Virginia – my home state – recently released a horrifying graphic: from 2016 to 2017, our rate of Acute HCV infections rose from 5.1 (out of 100,000) in 2016 to a staggering 9.1 in 2017(West Virginia Electronic Disease Surveillance System (WVEDSS), 2018). While these data are provisional (meaning that the finalized rate may be slightly lower), a 4-point increase in infection rates goes beyond a “call for alarm,” and into “disaster simulation” territory. Surrounding states – namely Ohio and Kentucky, as well as the District of Columbia – share equally troubling infection rates.

New findings published in the Journal of the American Medical Association Network Open indicate that, outside of Acute HCV infection incidence, HCV prevalence rates are high in several Appalachian and Western states. A total of 9 states (CA, TX, FL, NY, PA, OH, MI, TN, and NC) accounted for more than half (51.9%) of all persons living with HCV infection between 2013 to 2016 (Masoud, 2019).

So, what makes these prevalence numbers so different from infection rates (incidence)? For one thing, population. Incidence rates can be used to determine the likelihood or risk that someone will contract a disease. In states with a smaller population (like West Virginia), even though fewer people are contracting a given disease, the incidence rate will be higher than in a state where more individuals contract a new infection, but the population is exponentially larger.

For example: in 2016, there were 94 confirmed new Acute HCV infections in West Virginia, which had a population of 1,829,000, resulting in an incidence rate of 5.1 (out of 100,000 people); in New York, however, there were 179 confirmed new Acute HCV infections, but the population, there, was 8,615,000, resulting in an incidence rate of 0.9. The roughly 7 million additional people in the state lowers the risk of infection significantly.

With prevalence, we’re looking at the number of people who are living with a disease, regardless of whether or not they became infected during a specific year. So, if we are looking at a period of time – 2013 to 2016, for instance – anyone who was living with HCV during those years is counted in a prevalence count, even if they were notnewly infected during one of those years. To break it down in easier terms, “incidence” tells us the number of newly infected persons in a given year/period, whereas “prevalence” tells us how many people were living with the disease at that time.

What the JAMA Network Open study found was that the U.S. national prevalence for HCV from 2013-2016 was 0.84% in American adults who were not institutionalized and was adjusted upwards to 0.93% to account for those populations not included (Masoud). States whose prevalence rates were above that national average includes: AZ (1.10%), CA (0.99%), DC (2.32%), KY (1.16%), LA (1.30%), NM (1.61%), OK (1.71%), OR (1.48%), RI (1.16%), TN (1.28%), and WV (1.35%). Of these states, four are Western (AZ, CA, NM, and OR), and four are Appalachian (DC, KY, TN, and WV).

These findings indicate the need for additional resources, research, and outreach in Appalachia and the American West. Moreover, the study’s conclusion states that:

Prevalence of HCV infection varies widely in the United States. Highest rates are frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, particularly in the West. Progress toward hepatitis C elimination is theoretically possible with the right investments in prevention, diagnosis, and cure.

Truer words have rarely been spoken.

References:

__________

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.

Leave a comment

Filed under Uncategorized

Rural Missouri Seeing Increase in Hepatitis C

By: Marcus J. Hopkins, Policy Consultant

A news report from Ozarks First – a Nexstar Broadcasting, Inc. company – indicates that rural areas in Missouri are seeing an uptick in Acute Hepatitis C (HCV) cases. This, of course, is hardly news to anyone who has been tracking HCV in the United States over the past decade; increases in new HCV infections have been on the rise since at least 2012, with the hardest hit areas being rural Appalachia and rural New England.

Rural Missouri

Photo Source: ‘Home Stretch’ ~ Rural Missouri

What is frustrating about this article is the following section:

Meyerkord and Tucker especially recommend baby boomers get tested for the virus.

“Because so many folks came back from the Vietnam war, with Hepatitis C,” Meyerkord said.

“And the increase that people are seeing is partly because the baby boomers, it’s been recommended that they’re tested,” Tucker said (Ozarks First, 2019).

These statements need a bit of unpacking:

First and foremost, Lynne Meyerkord’s (Executive Director of AIDS Project of the Ozarks) attribution of HCV infection to the service in the Vietnam War is…troublesome, at best.

There are a number of reasons why the Birth Cohort (1945-1965) exhibit higher rates of Chronic HCV infection, the most relevant of which is the lack of Universal Precautions – standards that have been in place since the mid-to-late-1980s that dictates how medical personnel (e.g. – nurses, physicians, technicians, surgeons, et cetera) handle, disinfect, and sterilize the bodies, the clothing they wear, and equipment they use when dealing with patients. These precautions, introduced in no small part due to the outbreak of HIV in the 1980s, led to a revolutionary decrease in the spread of infectious diseases. The use of glass needles and other medical equipment that may not have been properly sterilized and disinfected (by today’s standards) was a large contributor to Birth Cohort HCV infection rates.

Additionally, advancements in technology allowed us to better screen, test, and identify bacteria and viruses in blood. HCV was only discovered in 1989, and it wasn’t until 1992 that reliable blood tests for the disease were created. This means that everyone who received blood or plasma products prior to 1992 was at risk of being exposed to HCV – anyone who underwent surgical procedures, received a blood transfusion, or was on hemodialysis was at risk for contracting the disease.

Thirdly, Injection Drug Use (IDU) was also a contributor to a significant portion of Birth Cohort infection rates. The increase in popularity of drugs like heroin in the 1970s, particularly among Veterans, led to a decent number of Baby Boomers being infected.

Service in Vietnam War has not, to the best of my knowledge, been identified as a primary means of infection within the Birth Cohort. Perhaps. Ms. Meyerkord meant to say that Veterans of the Vietnam War may have been exposed via IDU, but even then, it’s far likelier that members of the Birth Cohort were exposed in other manners.

The next part of those statements that needs unpacking is nurse Cindy Tucker’s statement about Baby Boomer infection rates. It istrue that the increase in new HCV infections is partly because the Birth Cohort are being tested more regularly for Hepatitis C. The U.S. Centers for Disease Control and Prevention (CDC), however, indicates that rates of new Acute HCV infections are being driven largely by people aged 20-49, with the 20-29 age demographic seeing astronomical increases in new infections (CDC, 2018).

The graph referenced from the CDC shows that, since 2010, rates of HCV have increased dramatically. Data indicate that much of this increase is attributable to IDU of prescription opioid drugs and heroin, which is both easier to obtain illegally and cheaper than illegally obtained prescription opioid drugs. These data hold particularly true in rural areas of the country, where the prescription opioid epidemic is ravaging communities.

So, while Ms. Tucker’s statement is “true,” it does need some further explanation.

AIDS Project of the Ozarks

Photo Source: TANF.us

The AIDS Project of the Ozarks provides medical, financial, and educational services in 29 counties in Southwest Missouri, and offers a wide range of services, including HIV testing and counseling, HCV testing (by finger prick), Case Management, Medical Care/Clinic Services, Family Case Management, Linkage to Care, Medication Adherence assistance, and a Client Pantry stocked with personal and cleaning products that cannot be purchased with SNAP Benefits (Supplemental Nutrition Assistance Program). Their main office is located in downtown Springfield, MO.

References:

__________

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.

 

Leave a comment

Filed under Uncategorized

Opioids Drive Hepatitis C Infections in New CDC 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

The Centers for Disease Control and Prevention (CDC) has released new data that estimate that approximately 2.4 million adults are living with Hepatitis C (HCV) in the United States (Hofmeister, et al., 2018). This estimate was reached by analyzing 2013-2016 data from the National Health and Nutrition Examination Survey to estimate the prevalence of HCV in the non-institutionalized population in combination with literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for incarcerated people, unsheltered homeless people, active-duty military personnel, and nursing home residents (Hofmeister).

Photo of the CDC Headquarters

Source: George Mason University

These data represent the latest effort by the CDC to more accurately reflect the severity of the HCV epidemic in the United States. The accuracy of this estimate has been significantly hampered by the failure of the CDC to classify HCV as a mandatorily reportable condition (like HIV). Instead, the CDC has left up to individual states whether or not they consider HCV a reportable condition, which has led to a range of wildly varying approaches from no reporting whatsoever, to incredibly detailed reporting that goes down to the county and/or jurisdictional level. These variations have led to certain states providing no functional data about the incidence or prevalence of this deadly virus in their states.

One of the primary drivers of new HCV infections has been the prescription opioid and heroin epidemic that extends into virtually every corner of the U.S.:

Earlier CDC research found that new hepatitis C cases tripled between 2010 and 2016. Most were traced to injection-drug use among younger adults addicted to heroin and other opioids. Adults under 40 have the highest rate of new infections (Norton, 2018).

In states where Injection Drug Use (IDU) is highly prevalent (suburban and rural areas of New England, the Midwest, and Appalachia), IDU accounts for a significant percentage of new HCV infections – in West Virginia and Massachusetts – the states with the second- and first-highest rates of HCV infection respectively – evidence suggests that it is the leading risk factor identified in HCV incidence reporting.

The recent news that Medicaid was expanded by voter ballot initiatives in Idaho, Nebraska, and Utah brings some hope that people living with HCV in those states will gain access to curative treatment. That said, even with Medicaid programs paying for treatment, it is both far cheaper, and more effective to prevent infection, rather than to play “Recovery Medic.” This can be effectively accomplished by establishing (and adequately funding) Syringe Services Programs (SSPs) which have been shown to reduce the number of new infectious disease infections and increase access to and utilization of drug abuse recovery services. Unfortunately, according to a 2017 CDC study, only three U.S. states have laws that “support full access” to both SSPs and HCV treatment (Norton).

For those of us in the HCV data game, these data are of little surprise. While this latest CDC estimate is down from the previous one, there are factors to consider when looking at this decrease: the introduction of HCV Direct-Acting Antivirals has decreased the number of people living with HCV as access to these medications has increase and people who wereliving with HCV have died in greater number as their disease ravaged their livers and other bodily organs. Essentially, people either got cured, or they died (Norton).

References:

__________

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.

Leave a comment

Filed under Uncategorized

Rural America Continue to Struggle with Opioid Addiction

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

In 1999, the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths were higher in metropolitan (urban) areas than in non-metropolitan (suburban/rural) areas – a rate of 6.4 vs. 4.0 (per 100,000). In 2015, that trend has reversed, with non-metropolitan overdose deaths more than quadrupled in number with a rate of 17.0, while metropolitan areas had a rate of 16.2 (CDC, 2017).

From these data we can surmise a few things:

  1. The population in the U.S. did not decrease from 1999 (279 million) to 2015 (321 million);
  2. Despite this population increase (+42 million), the total number of drug overdose deaths has increased exponentially;
Medical technician counting needles.

Photo Source: Daily Beast

So, what changed during this period? According to the American Society of Addiction Medicine, from 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel:

  • The overdose death rate in 2008 was nearly four times the 1999 rate;
  • Sales of prescription pain relievers in 2010 were four times those in 1999;
  • Substance use disorder treatment admission rate in 2009 was six times the 1999 rate
  • In 2012, 259 million prescriptions were written for opioids – more than enough to give every American adult their own bottle

Along with these sobering (as it were) statistics, four out of five heroin users started out abusing prescription painkillers. Also, 276,000 adolescents aged 12-17-years-old were current non-medical users (abusers) of prescription pain relievers, with 122,000 having an addition to prescription pain relievers. 21,000 adolescents had used heroin in the past year, and an estimated 5,000 were current heroin users (American Society of Addiction Medicine, 2016)

Essentially, as the rate of prescribing opioids increased over time, so too have the rates of addiction and overdose deaths. That said, the opioid prescribing rate has declined from 2012-2017 and is currently at the lowest level in ten years, from 259 million in 2012 to 191 million in 2017.

Even with this decline, reversing the damage already done is going to take at least a generation to fix, particularly when it comes to adequately addressing opioid and heroin addiction (inclusive of treatment, recovery, and relapses). Moreover, there are vast disagreements in how we, as communities, counties, states, and a nation, should best go about dealing with these issues.

Despite the fact that we have hard scientific data and evidence that certain measures work better than others (e.g. – Harm Reduction measures like Syringe Services Programs (SSPs) and Medication-Assisted Treatment (MAT)), it is difficult to convince elected officials to legalize, authorize, and fund these measures. This is largely due to long-standing, albeit factually inaccurate, objections that SSPs are essentially “enabling” or “condoning” drug use and abuse.

One small town in Washington state – Stanwood – has decided to approach their burgeoning opioid addiction problem like they would a natural disaster, the same way they would mobilize and respond to a landslide or flu epidemic:

…the response to the opioid epidemic is run out of a special emergency operations center, a lot like during the Oso landslide, where representatives from across local government meet every two weeks, including people in charge of everything from firetrucks to the dump (Boiko-Weyrauch, 2018).

The name of this group is the Multi-Agency Coordination group (MAC group), and has seven big, overarching goals which are broken up into manageable steps, like distributing needle cleanup kits and training schoolteachers to recognize trauma and addiction. Police officers enter illegal homeless encampments in wooded areas not to arrest them, but to help link them to drug treatment and housing resources, as well as to provide other assistance, such as food, coffee, and transportation to and from appointments (Boike-Weyrauch).

This approach to policing the opioid epidemic is slowly becoming more popular, but again, convincing states, counties, and local municipalities to adopt this strategy is incredibly difficult due to the long-standing opposition against the use of public resources for these purposes. The concept of treating addiction as a disease, rather than as a crime to be punished isn’t an easy pill to swallow for those who believe that only the individual is responsible for dealing with their health issues; who have abandoned the concept that addressing the welfare, health, and safety of all citizens will lead to greater results than leaving people to their own devices.

As part of the Community Access National Network’s ongoing research, we provide state-by-state analysis of various Harm Reduction measures (e.g. – SSPs, Naloxone Access, and Provider Education Requirements) in our monthly publication, the HIV/HCV Co-Infection Watch. Our October edition can be found here: http://www.tiicann.org/co-infection-watch.html

References:

__________

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.

Leave a comment

Filed under Uncategorized

South Carolina Has a Liver Problem

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

It is the conventional wisdom that the Southern United States play host to health epidemics of several sorts – obesity, premature deaths, diabetes, heart disease, higher risks of cancer… To say that health issues in the South are prevalent is to say that the Great Pyramid of Giza is a small rock formation. With all those troubles, South Carolina has a growing problem: liver cancer deaths.

In just six years (2010-2016 – the best available information) liver cancer deaths rose 43% in adults aged 25 and older. When you focus on age groups, adults aged 55-64 saw a staggering 109% increase (National Center for Health Statistics, 2018). The rate of death in South Carolina falls in the range of 10.0-11.9 (per 100,000 – the NCHS report doesn’t list the specific rates), putting it above the national average, and sadly, three other Southern states – Texas, Louisiana, and Mississippi – all have higher death rates from liver cancer.

South Carolina

Photo Source: aventalearning.com

This rise in liver cancer deaths conveniently (for lack of a better word) coincides with a sharp increase in the number of Hepatitis C (HCV) infections. HCV is a disease that specifically impacts hepatic (liver) health and function, and the NCHS report indicates that HCV is likely the greatest factor in this increase (Osby, 2018).

Essentially, part of why HCV incidence reporting is so finicky is that testing and screening protocols are not standardized across the U.S. Each state essentially establishes its own screening guidelines, and the vast majority have failed to update said guidelines to reflect the growing face of the epidemic at hand – Injection Drug Use (IDU). Certainly, the U.S. Centers for Disease Control & Prevention (CDC) recommends testing for anyone who is or has participated in IDU, but the reality is that few people are willing to come forward about those actions on a voluntary basis; how can a physician proactively test patients for HCV if they don’t disclose current or previous IDU?

One step to help identify HCV infections, for which HEAL Blog has advocated, is using emergency care settings as mandatory HCV screening locations. The thinking behind this is that, rather than attempting to ferret out potential IDU among patients, HCV testing should be offered to all Emergency Room (ER) patients, regardless of apparent risk factors. Heck, even a half measure of testing every overdose victim in emergent care situations (on 911 calls and ER arrivals, for example, using rapid testing and immediate linkage to care) would be better than the system we currently have in place.

More than just advocacy, research is bearing out this measure. In a study published in Academic Emergency Medicine, HCV tests were performed at Boston Medical Center on 3,808 patients at least 13 years old undergoing phlebotomy (blood work) for clinical purpose (Schechter-Perkins, et al., 2018). The tests were performed in a nontargeted, opt-out method, meaning that patients had to provide informed refusal of the test. The results of this three-month effort resulted in 292 confirmed positive HCV patients (7.7% of all patients tested).

While this number may sound low, the breakdown of those results is telling: 155 of those 292 (53%) fell outside the Birth Cohort (1945-1965) for whom the CDC recommends one-time HCV testing, 46 of whom reported no IDU as a risk for infection. The breakdown, post-testing, occurred (as it usually does) with attempted linkage to care: linkage attempts were documented on 223 76.4% of those identified as testing positive for HCV, and follow-up appointments were scheduled for 102 (38% of attempted linkages). Only 66 out of 292 attended that follow-up appointment (22.5% of all RNA-positive patients).

So…is it the best solution? Potentially, given the abject failure of state and national politicians to grasp the severity of this epidemic and respond to it with even adequate increases in funding. A few states – California, for example – have responded for those on their Medicaid rosters, but only in terms of affording treatment. How do we treat people who haven’t been tested, particularly if there’s insufficient funding for testing? It’s all going to take money, and if we don’t pony up the costs ahead of time, it’s going to cost all of us exponentially more – in both financial, and human terms – further down the line.

References:

  • National Center for Health Statistics. (2018, July). Trends in Liver Cancer Mortality Among Adults Aged 25 and Over in the United States, 2000–2016, NCHS Data Brief, No. 314. Atlanta, GA: United States Department of Health and Human Services: Centers for Disease Control and Prevention: National Center for Health Statistics. Retrieved from: https://www.cdc.gov/nchs/data/databriefs/db314.pdf
  • Osby, L. (2018, July 23). Liver cancer deaths soar in South Carolina, across the US. Greenville, SC: The Greenville News. Retrieved from: https://www.greenvilleonline.com/story/news/2018/07/23/liver-cancer-deaths-soar-sc-nation/806045002/
  • Schechter-Perkins, E.M., Miller, N.S., Hall, J., Hartman, J.J., Dorfman, D.H., Andry, C., & Linas, B.P. (2018, May 31). Implementation and Preliminary Results of an Emergency Department Nontargeted, Opt‐out Hepatitis C Virus Screening Program. Academic Emergency Medicine. https://doi.org/10.1111/acem.13484

__________

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.

Leave a comment

Filed under Uncategorized

Kentucky Moves to Prevent Vertical Hepatitis C Transmission

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

The Commonwealth (state) of Kentucky has become the first state in the U.S. to require pregnant women to be tested for the Hepatitis C virus (HCV). This comes as the state is in the grasp of a crippling opioid addiction epidemic that has led to an increased number of new Acute HCV infections in the Appalachian Mountain region (Smith, 2018). This may, in fact, be the first piece of U.S. legislation that makes mandatory the testing of any specific demographic who are not incarcerated, as I have yet to see another law that requires testing, rather than simply mandate that a certain demographic – usually the Birth Cohort (people born between 1945-1965 – be offeredtesting.

The article cited above makes a curious claim:

“The disease can easily spread from mother to child, so starting this month, pregnant women in Kentucky must be screened.”

This asertion is questionable, at best, as the most recent data I’ve seen from the Centers for Disease Control and Prevention (CDC) indicates that vertical transmission occurs in only 5.8% of infants born to mothers monoinfected with only HCV, and 10.8% of infants born to mothers co-infected with HIV and HCV (Koneru, 2016). While vertical transmission is certainly a concern, the data available do not support the claim being made, nor do they necessitate the passage of mandatory testing protocol. In fact, CDC recommendations, which admittedly have not been revised since 2015, list pregnant women under “Persons for Whom Routine HCV Testing Is Not Recommended (unless they have risk factors for infection)” (CDC, 2015).

HCV Screening

Photo Source: Passport Health

I am certainly in favor of universal screening protocols, as evidenced by myriad HEAL Blog posts calling for expanding testing protocols to make testing mandatory in all healthcare settings. That said, it is curious to me that Kentucky has chosen pregnant women as the target of mandatory testing. The cynic in me wonders if this is truly a forward-thinking approach to reducing incidence of HCV transmission, or if it serves another, less altruistic purpose: using test results to infer opioid abuse.

Much of the HCV epidemic in Kentucky can be traced back to Injection Drug Use (IDU) of prescription or illicit opioid drugs (and occasionally stimulants such as methamphetamine). As of June 2018, in 22 states and the District of Columbia, substance use during pregnancy constitutes child abuse, and in three states ((MO, SD, and WI) can result in civil commitment (Guttmacher Institute, 2018). The state of Kentucky has not, yet, criminalized substance use during pregnancy, but given the current political temperament in the state, it isn’t outside the realm of possibility that state legislators will do so in the future. I fear, though there is no current evidence that this is the case, that legislators may use any findings of increased vertical transmission of HCV – HCV infection that may be attributed to IDU – as cause to join those 22 states and DC.

My secondary concern relates to the affordability of HCV testing. The costs of pregnancy are consistently increasing, while wages have remained relatively stagnant. Kentucky’s poverty rate hovers around 19.0%, which makes the various costs associated with being pregnant already burdensome; adding an additional testing requirement that may increase the amount of out-of-pocket spending for pregnant families is a concern.

Those concerns aside, it is always a good thing when HCV testing protocols are expanded. It will be interesting to see if this change in protocol will result in a higher incidence of new Acute HCV infections, or if it will have the desired impact of reducing vertical transmission.

References:

  • Centers for Disease Control and Prevention. (2015, October 15). Testing Recommendations for Hepatitis C Virus Infection. 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 Viral Hepatitis: Hepatitis C Information: Testing Recommendations. Retrieved from: https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm
  • Guttmacher Institute. (2018, June). Substance Use During Pregnancy. New York, NY: Guttmacher Institute: State Laws and Policies. Retrieved from: https://www.guttmacher.org/state-policy/explore/substance-use-during-pregnancy

__________

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.

1 Comment

Filed under Uncategorized