Tag Archives: Hepatitis C

Cherokee Nation Chooses to Proactively Fight Against Hepatitis C

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

Native Americans (NAs) in the United States have largely gotten the shaft. Forced from their native lands, herded into reservations, and the victims of innumerable false promises and broken agreements on the part of the U.S. government, NAs have also had the misfortune of being disproportionately impacted by infectious disease. Such is the case with Hepatitis C (HCV). According the most recent Surveillance for Viral Hepatitis report released, this year, by the Centers for Disease Control and Prevention (CDC), NAs have by several integers the highest rate of HCV per 100,000 people out of any race demographic with a rate of 12.95 (CDC, 2017). The Cherokee Nation – the second-largest NA tribe in the U.S. – has decided to actively come out swinging against HCV.

White House honors CN physician for hepatitis C program

Photo Source: Cherokee Phoenix

Roughly 130,000 Cherokee Nation (CN) tribal citizens live in northeastern Oklahoma within the tribe’s boundaries, and within this community, aggressive measures are being taken to combat the disease. Dr. Jorge Mera (seen in the photo being honored by the Obama Administration for his Hepatitis C program), Head of Infectious Diseases at Cherokee Nation in Tahlequah, OK has worked with various agencies and private partners to create a comprehensive approach to dealing with their HCV epidemic (Taylor, 2017):

  • Using newer Direct-Acting Antivirals (DAAs) to treat and achieve Sustained Virologic Response (SVR) in infected tribe members
  • Partnering with Gilead Sciences (makers of three currently available HCV DAAs – Sovaldi, Harvoni, and Epclusa) to receive funding for screening kits and research through the Gilead Foundation
  • Adopting a proactive compulsory screening policy of screening all tribe members aged 20-69 for HCV (rather than just the Baby Boomer Birth Cohort), as well as offering tests to all children of any mother who screens positive for HCV
  • Expanding screening locations to include dental clinics to screen tribe members who may not access other healthcare services
  • Pushing and receiving approval for the establishment and funding of a tribal Syringe Services Program (SSP – Syringe/Needle Exchange) within the tribe’s territory (Hays, 2017)

This type of aggressive approach to combating HCV is, in fact, the type of action that Viral Hepatitis (VH) advocates have been pushing for years, but the unique circumstances under which tribal healthcare operates allows for more freedom than in the greater U.S. “Because Cherokee Nation citizens, under a treaty right with the United States Government have access to medical care, tracking them, and screening them is slightly easier than might be so for other US populations,” explains Dr. Mera (Taylor). Additionally, since their focus is on a smaller, specific population, the CN is able to focus its care on a smaller pool of individuals, rather than attempting to address the healthcare needs of millions of citizens.

That said, HCV transmission does not occur within a vacuum – tribe members do come in contact with people who fall outside of the tribe’s jurisdiction, meaning that, even if the CN’s efforts to screen, track, and cure all members of the tribe within its boundaries are 100% successful, they are still susceptible to new infections by way of contact with those outside of their community. This means that the types of progressive Harm Reduction, screening, and treatment measures being undertaken by CN need to be replicated in the state of Oklahoma, as well as the surrounding states (and eventually, the entire U.S.) in order for their efforts to not be undermined by failures to provide similar services on the parts of state and Federal governments.

These tactics also serve as a roadmap for dealing with HCV in some of the states hardest hit by the disease, particularly in smaller Appalachian states like West Virginia and Kentucky, where geography and smaller, more remote populations make reaching, screening, tracking, and treating not only HCV, but every health condition more difficult.

The tribe will present its progress at the World Indigenous People’s Conference on Viral Hepatitis in Anchorage, AK on August 08-09, 2017. For more information on that conference, please click on the following link: WORLD INDIGENOUS PEOPLES’ CONFERENCE ON VIRAL HEPATITIS

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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Michigan Hepatitis C Surge Related to Prescription Opioid and Heroin Abuse

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 Michigan Department of Health and Human Services (MDHHS) released its 2016 Hepatitis B and C Annual Surveillance Report, indicating drastic increasing in new Chronic Hepatitis C (HCV) cases in the state, particularly among residents aged 18-29. Two factors posed significant roles in the transmission of these cases – Injection Drug Use (IDU) and Incarceration.

HEAL Blog has consistently reported on HCV transmission as a result of IDU and within incarceration settings, and report is further evidence of those positions. There were 11,883 new Chronic HCV cases reported in 2016 for a rate of 119.78 out of every 100,000 people. 69% of those cases were followed up on and epidemiological profiles were made; of those IDU was a risk factor in 64% of cases, while incarceration was a risk factor in 63% (MDHHS, 2017).

More striking, however, was the vast increase in Chronic HCV in people aged 18-29 between 2005-2016 – an alarming 473%, of which 84.2% were reportedly related to IDU in that same age group. This trend is replicated all over the country, especially in areas where prescription opioid and heroin abuse levels are more prevalent.

Logo for the Michigan Department of Health & Human Services

Photo Source: MDHHS

MDHHS reported that viral hepatitis-related hospitalizations, liver cancer incidence, liver transplants, and viral hepatitis deaths have all increased over the last decade, largely driven by the impact of Chronic HCV infections (Mack, 2017). With so many of these cases ostensibly linked to opioid and heroin abuse, a robust response to the addiction epidemics is needed, as well as compulsory “Opt-Out” screening at clinics, emergency rooms, hospitals, and correctional settings.

The Lansing City Council recently voted to allow Syringe Services Programs (Syringe/Needle Exchanges), a proactive Harm Reduction measure that studies indicate reduces the rate of transmission amongst both People Who Inject Drugs (PWIDs), as well as the general population (Cook, 2017). Selling these programs to citizens who are unfamiliar with the programs, staunchly opposed to drug use, or believe that the exchanges encourage drug use remains a difficult proposition. Proponents argue that PWIDs are going to use drugs, regardless of whether or not there are exchanges; that being the case, it makes logical sense to prevent the spread of disease.

Michigan’s increase in Viral Hepatitis (VH) follows a national trend that will be replicated – possibly with farther reaching, deadlier impact – in other states.

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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Compulsory Viral Hepatitis Screening is a Pathway to Elimination

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

At the International AIDS Society’s (IAS’) 4th Annual HIV/Viral Hepatitis Co-Infection Meeting in Paris, France, aside from all of the various data regarding rates of infection around the globe and various approaches to eradicating Hepatitis B and C (HBV/HCV, respectively) by the World Health Organization’s (WHO’s) target year of 2030, one assertion rang true throughout: all of these projections and approaches will require robust Harm Reduction measures to be put in place.

For the uninitiated, Harm Reduction measures are various laws, regulations, and statutes put into place in order to reduce injury or death from a specific cause; a good example of this would be a Seat Belt Law. As they relate to Viral Hepatitis (VH), Harm Reduction statutes include various methods of reducing the likelihood of infection (and thereby death), such as the mandatory use of Prescription Drug Monitoring Programs (PDMPs), ID requirements for the purchase of prescription opioid drugs, and prescriber education about the risks of prescribing opioids and proper opioid usage. One set of measures, however, would serve several purposes: mandatory or compulsory screening requirements for HIV, Hepatitis B, and Hepatitis C.

"Hepatitis" on a screen, with a stethoscope

Photo Source: CTV News

A handful of states (CT, FL, MA, NY, and PA) have considered or passed mandatory screening guidelines for the Birth Cohort (people born between 1945-1965). These guidelines are largely inefficient, because they rely upon an “Opt-In” method of screening, meaning that patients are offered screening, and must accept – it’s optional. Additionally, these measures focus only on the Birth Cohort, and understandably so, as they represent the largest percentage of existing HCV cases. These approaches, while well-intentioned, must be amended and updated on a national level, in order to effectively combat the spread of both HBV and HCV.

An estimated 70% of new Acute HCV infections are related to Injection Drug Use (IDU) by People Who Inject Drugs (PWIDs). That none of these screening guidelines make mention of these facts is indicative of our inability to accurately capture the data we need in order to adequately assess the scope and scale of the epidemic. Statistics at the state and national levels are largely reached using modeling that projects an estimated number that ostensibly accounts for underreporting. PWIDs are, however, notoriously difficult patients from whom to capture data, in no small part because we see them consistently in only a handful of healthcare settings: Hospitals for overdoses, Prisons, Jails, and Juvenile Detention Centers for incarceration, and Rehabilitation facilities. In addition, Syringe Services Programs (SSPs) are another excellent point of data collection, but it must be handled differently than those previously listed.

The most effective method of screening is to make it compulsory (mandatory) on an “Opt-Out” basis in which patients are informed that screening for HIV, HBV, and HCV are part of a required set of screenings, and they must provide “informed refusal” of the test. This requires that all hospitals, clinics, justice/incarceration settings, and rehabilitation facilities adopt this method of screening in order for the most effective use of time and money that will result in the most accurate data captures. When opioid and heroin users overdose and are the recipient of emergent care services, this is the prime location to capture data from PWIDs. The same holds true for those who are moved into justice settings, as well as those who enter rehabilitation services. Additionally, with the use of rapid HCV antibody testing, this can be accomplished in a relatively short period of time. The important part is ensuring that each Positive test result is followed up with an immediate secondary confirmatory screening, rather than scheduling a second appointment.

These types of compulsory screening requirements are paramount to achieving the WHO’s goal of eradication of HBV and HCV by 2030. Once patients know their status, with proper linkage to care services, they can be cured of HCV and treated for HBV with relative ease. This will, of course, require an investment on the part of state, Federal, public, and private partners, and until we have Federal movement on these issues, the best location to start is at the state-level. Personally, I am working on an endeavor with one of West Virginia’s delegates to work on building a workable and FUNDED compulsory screening requirement as close to the one I suggested above, given the complex nature of WV’s budgetary constraints. We at HEAL Blog invite you to do the same, in order to ensure that compulsory screening becomes a reality.

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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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Viral Hepatitis Funding Lowest in States Most at Risk

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) recently released the data related to Viral Hepatitis (VH) surveillance in the U.S. for 2015, and the picture is…grim. While many states saw relatively stable rates of new Acute Hepatitis C (HCV) infections, two states – AL and PA – experienced 100% increases from 2014 (CDC, 2017). CDC funding for states’ respective Viral Hepatitis programs, however, tends to fall short in states where rates of infection are high relative to the population (The AIDS Institute, 2017).

Infection rates are generally calculated by taking the number of total infections, dividing that by a state’s total population, and multiplying that result by 100,000 to calculate how many people, on average, will be infected for every 100,000 residents. For example:

The state of West Virginia reported 63 new cases in 2015; the state has a population of 1,844,000, so 63/1,844,000 = 0.00003416 x 100,000 = 3.416 rate of infection.

West Virginia, despite being the 14th least populous state (including the District of Columbia), has the second highest rate of new HCV infections in the U.S., second only to Massachusetts, which has a rate of 3.7. The following chart lists the top ten states in order of highest infection rate, their respective populations, and the amount of funding in those states for VH:

Chart showing 10 states with highest viral hepatitis infections also having lowest state budgets to combat the disease, including MA, WV, KY, TN, ME, IN, NM, MT, NJ, NC

The above chart seems to be indicative of two things irrespective of a state’s population: (1.) certain states make VH funding a priority, while others do not; (2.) states are simply not receiving enough funding from the Federal government and the CDC to bring their VH programs up to funding levels adequate enough to effectively combat VH.

Each of these states has a number of factors contributing to their respective rates of infection: (1.) Aging populations (Baby Boomers born between 1945-1965); (2.) High rate of Injection Drug Use related to opioid drugs, heroin, or stimulants; (3.) Sharp increase in the number of tests administered, resulting in higher rates of positive results.

What is clear is that funding for VH is woefully inadequate if the U.S. intends to eradicate HCV from the U.S. by 2030.

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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Illicit Tattoos and Piercings Increase Risk of Hepatitis C

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

Early this month, police in Pulaski, Virginia arrested four men for unlicensed tattooing – a misdemeanor offense with a fine of $2,500 and a maximum penalty of one year in jail. The investigation into the illegal tattooing operations began in May 2017, when police received a warning from the Pulaski County Health Department (PDHD) of a rapid increase in the number of new Hepatitis C (HCV) infections in patients who had recently received a tattoo in the area surrounding Meadowview Apartments near the 800 block in Pulaski (WDBJ 7, 2017).

While tattoos and piercings were relatively uncommon during the 1980s, the less conservative 1990s gave birth to a rise in the popularity of both. Now, nearly 4 in 10 people born after 1980 have a tattoo, and 1 in 4 have a piercing in a location other than an earlobe (Mercer, 2017). While most people have their tattoos and piercings done by licensed professionals, the high cost of body art leads many people to seek out less reputable, unlicensed tattoos that can be done cheaply and off the books.

Makeshift tattoo artist

Photo Source: India Times

Others, still, manage to acquire their tattoos via even less professional means than that while in jail or prison. In late June 2017, authorities at the Bladen County Jail in Bladen County, North Carolina, found a makeshift tattoo gun after being told that three inmates received tattoos and that one of them had contracted HCV. Jailers then found that two other inmates received tattoos from the makeshift device, and they are now being tested for the disease (Donovan, 2017). Further complicating matters is that jailers are uncertain where the HCV-infected inmate contracted the disease in jail or was infected prior to being incarcerated. Screening for HCV is required during the intake process, but few jails follow this protocol.

Part of the reason why work from licensed artists is so expensive has to do with the safety regulations rightly put in place to avoid the types of infections faced by Pulaski residents. Proper cleaning, sanitation, storage, and tattooing procedures is supposed to be closely monitored by state health departments as part of the licensing process, which does drive up the cost of the practice. However, each state is left to its own devices when it comes to regulating body art. North Carolina, for example, has a law dating back to the 1990s that regulates tattoos, but fails to regulate other forms of body art (e.g. – branding, piercing), meaning that artists to provide those services do not receive the same level of scrutiny as tattoo artists (Mercer).

These safety issues exist in every state in the U.S. Public health officials in Fargo, North Dakota, recently issued a warning after people in the metro region contracted HCV and HIV through illegal tattooing (Filley, 2017). The allure of cheap body art is often the primary reason why people go to “this guy I know who does cheap tattoos.” Unfortunately, “that guy you know” likely isn’t licensed, and putting one’s life into his hands, regardless of the quality of the artwork, may result in longer-term consequences than just a bit of ink.

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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U.S. Air Force Clinic Risks Potential Exposure

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

If one thing has been certain in the world of medicine since the discovery of HIV/AIDS, it’s that medical safety standards must always be followed. For 135 people receiving treatment at Al Udeid Air Base clinic in Qatar, a failure to properly “[clean] in a manner [consistent] with sterilization guidelines” opened them to the risk of exposure to HIV, Hepatitis B (HBV), and Hepatitis C (HCV).

Map of Al Udeid Air Base in Qatar

The issue is related to endoscopes – an illuminated optical (camera) used for upper and lower gastrointestinal procedures. As endoscopies are invasive procedures, failing to properly sterilize these medical devices poses a serious risk to anyone who undergoes procedures using them. The process for cleaning endoscopes has been readily available to all medical staff well before April 2008, the date when the devices were identified as having been improperly cleaned. These failures to follow basic sterilization protocols, particularly in a military base medical center, are unacceptable. That no one apparently noticed the improper sterilization methods until April 2016 is simply intolerable.

The issue came to light Monday, June 19, 2017, when the Air Force Surgeon General revealed the information in a press release. Sadly, this is not the first time that the U.S. Air Force (USAF) have had issues with improperly handled endoscopes. In September 2016, 267 patients at the Air Force Academy’s medical clinic in Colorado were notified that they were at risk for a number of infectious diseases due to improperly sterilized endoscopy equipment (Kime, 2016). While these instances are not exactly alike in circumstance, they do bring into question the training and quality of care provided by these clinics.

U.S. military and veteran clinics have consistently come under fire, over the past two decades, in no small part because of their failure to follow basic protocols that have been in place and consistently updated since the early 1990s. Numerous reports over the past two decades indicate a failure on the part of military and veteran medical personnel to protect patients from HIV, HBV, and HCV infection risks, causing many citizens and legislators to bring into question the quality of the healthcare provided. With rare exception, all of these incidents relate to the sterilization of medical implements that are supposed to be adhered to at every level of medical practice, from veterinarians to surgeons, and yet, military medical personnel just can’t seem to get it right.

Photo of Command Surgeon Colonel Walter Matthews

Source: LinkedIn

Every time one of these incidents occur, military personnel attempt to play down the risk of exposure: in the September 2016 Academy issue, Command Surgeon Colonel Walter Matthews said that the risk of infection to patients was “low, but it is not zero.” In the current scandal, Larine Barr, a spokeswoman for the surgeon general, said that the risk of infection is “very small, particularly in a deployed environment” (Losey, 2017). While these platitudes may be a great way to mollify everyone else, they serve as small comfort to those facing the risk of infection.

At what point will military and veteran medical personnel be subjected to the same level of scrutiny as every other part of the medical community? While timeliness and meeting deadlines is understandably important, these are the types of mistakes made by first-year trainees, not those in whose hands the lives and wellbeing of patients is being placed. Clearly, something needs to be done to ensure that all medical personnel are properly trained, and are consistently following every sterilization protocol; if they cannot live up to that very basic standard, they have no business providing medical services.

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 Policy Project Releases Report on HCV Monitoring in the U.S.

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

Report Cover: "Monitoring the Hepatitis C Epidemic in the United States"

Source: Hepatitis Policy Project

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.

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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