Tag Archives: HIV

Iowa Prison Systems Prepare for HIV & HCV Uptick

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

Iowa’s Department of Corrections (IDOC) has put in a request for additional funding for the 2019 fiscal year (FY19) in anticipation of potential upticks in new HIV and Hepatitis C (HCV) infections within Iowa’s jails, prisons, and youth correctional facilities as a result of increased abuse of prescription opioids and heroin. Jerome Greenfield, Health Services Administrator for IDOC, has requested an addition $1 million budget increase to accommodate increased pharmaceutical costs for the treatment of HIV and HCV (Pfannenstiel, 2017).

State Seal: Iowa Department of Corrections

Photo Source: IDOC

For each year from 2010 to 2015, between 12%-14% of Iowa’s incarcerated population tested positive for HCV, though these data account only for the individuals incarcerated at any given point in time, and do not account for the movement in and out of IDOC facilities (Iowa Department of Public Health, 2017). Of those entering into the IDOC system and who warranted screening, over 91% were screened for HCV in FY14, with a 5.6% testing positive; in 2015, over 78% were screened, and 4.5% tested positive. While the number of positive tests results decreased in 2015, that may be a result of fewer inmates being screened.

The budget request comes at a time when the state is grappling with a potential $75 million budget shortfall as a result of lower-than-expected revenue returns during the last fiscal year that ended June 30th, 2017. The IDOC, itself, suffered a $5.5 million budget cut in FY17, and a $1.6 million cut for FY18, making the likelihood of this request being fulfilled dubious, at best. For its part, IDOC officials believe that, should any more cuts be implemented, they will have to reduce staffing in order to deal with those losses. This means fewer correctional employees, which can create a hostile environment, leave inmate needs and concerns unmet, and foment distrust and enmity between inmates and correctional facility staff. As we saw in Delaware, earlier this year, this type of environment can lead to prisoners protesting and/or rioting (Oh, 2017).

Iowa’s also dealing with an explosion of new HCV diagnoses, which have more than quadrupled since 2009 among people between 18 and 30 (Carver-Kimm, 2017). For those from whom data were collected, over 51% reported Injection Drug Use (IDU) as a risk factor (Iowa Department of Public Health, 2017). The state is also making considerable inroads to combating the HCV epidemic within the state with seven local health departments and one Federally Qualified Health Center (FQHC) that administer HCV testing and Hepatitis A and B immunizations. These agencies, known as Counseling, Testing, and Referral (CTR) sites, are located in the state’s most populous counties, test only people who have ever injected drugs, and offer free HCV screening for anyone who reports having ever injected drugs.

In 2016, former Iowa Governor, Terry Branstad, signed a bill expanding access to Naloxone, a drug that reverses or blocks the effects of opioid medications. While advocates cheer the move as an excellent tool to save the lives of People Who Inject Drugs (PWID), they are also pushing the Iowa state legislature to legalize Syringe Services Programs (SSPs – Needle/Syringe Exchanges). Research consistently shows that SSPs lead to reduced rates of HIV, HCV, and HBV infections among PWID, as well as those who are sexually involved with PWID.

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

E-mail Undeliverable; HCV Patients Left in the Dark

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 was a simple task: comb the Internet for a list of Hepatitis C (HCV) support groups in the U.S. with e-mail addresses as a point of contact, compile them into a spreadsheet, and contact each of them to invite them to access and distribute our free monthly HIV/HCV Co-Infection Watch report. Over a period of two weeks, I managed to gather information on 206 support groups with e-mail contact points, and this past week set about contacting each group with our information. Of the 206 e-mails I sent over two days, 63.1% of them were returned as “Undeliverable.” The rejected e-mails came back for a variety of reasons – closed/frozen accounts; full inboxes; hosts that no longer exist – and for each returned e-mail a problem became clearer: we have a support group problem.

E-mail undeliverable message

In collecting the data, I discovered that eleven states (DE, NE, NH, RI, SD, TN, UT, VT, WV, WI, WY) had no HCV support groups with e-mail addresses as points of contact (that I was able to locate). After compiling the data from the returned e-mails, another eleven states (AK, AR, CO, HI, ID, IL, LA, MN, NJ, OR, VA) had no HCV support groups with functioning e-mail addresses. This amounts to a total of twenty-two states without e-mail contacts for HCV support groups.

In all fairness, that doesn’t mean that there are no HCV support groups in those twenty-two states; just that there are no working e-mail addresses listed (that I could find in two weeks) for those states. Every state has at least one support group with a contact phone number, but because those were outside of the parameters of my assignment, they were not included in the data. Given that e-mail is arguably the most-used form of information gathering after searching websites, it creates a significant barrier to HCV patients gaining access to support services.

The paucity of support groups has largely been eliminated for HIV patients. After nearly forty years, many of the support systems are largely in place for patients living with HIV. This is in no small part a result of the tireless efforts of millions of people working to ensure that patients living with HIV have those support networks in place, should they choose or have the desire to use them. Typing “HIV Support Groups” into a Google search bar results in literally thousands of different options for support services; organizations by the hundreds list the various support groups for patients, family members, spouses, children, friends, neighbors, employers, employees…the list of groups is endless. This is not the case for HCV.

Beyond just support groups, lower-income HIV patients also enjoy (for lack of a better word) access to Ryan White programs that were designed to help patients living with HIV to afford the costs of medications, treatments, healthcare, and other costs of living with the disease. HCV patients, however, must rely upon manufacturer- or privately-funded Patient Assistance Programs (PAPs) that are not operated by either state or Federal agencies. Despite both the high cost of HCV medications and the efficacy of the Ryan White program in reducing the number of HIV-related deaths and increasing access and adherence to HIV treatment, there seems little appetite for either creating a similar program for, or opening up the Ryan White program to include HCV patients.

We must do better. In the modern Age of Technology, there is no good reason that HCV patients should have to muddle through incorrect or outdated contact information to access support groups. There is no reason for HCV patients to go without the types of services provided by doctor offices, hospitals, and clinics to HIV patients in accessing these support services. It is unconscionable for us, as one of the most advanced nations on the planet, to continue to fail the HCV community.

__________

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

Scott County and Indiana’s Steep Learning Curve on HIV and 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

In early 2015, Scott County, Indiana was thrust into the global spotlight for an HIV outbreak among injection drug users abusing opioid prescription drugs and heroin (Hopkins, 2015). In a county that averaged a total of 5 new HIV infections each year, even doubling that number would’ve been a statistical anomaly. By the end of 2016, the county had 216 new HIV infections in the span of just two years, and of those, 95% were co-infected with Hepatitis C (HCV). So rare was the disease that county health department officials had never handled HIV cases, instead sending them all to the regional Sexually Transmitted Diseases Department in Clark County (May, 2016).

The outbreak in Scott County was, and still is, both instructive and reflective of several concurrent health crises faced by most of rural America. In one county, virtually every major health risk met in the middle: a prescription opioid addiction problem, the resultant heroin usage problem, and an access to comprehensive healthcare problem all walked into a bar, and out came one of the worst concentrated HIV epidemics in the U.S. in the past decade. Throw in a paucity of drug addiction, recovery, and Syringe Services Programs (SSPs), and you had the perfect case study for how outbreaks occur.

To be fair to Indiana’s legislature and then-Governor Mike Pence, the state responded intelligently to the crisis by legalizing for the first time SSPs…under certain previsions. Counties had to apply for approval, had to show that they had funding, and had to be located in a high-risk zone. Since Mike Pence’s departure from the state to swampier D.C. pastures, his replacement has actively attempted to ease those restrictions. Earlier this year, the Indiana General Assembly passed a bill allowing local governments to establish syringe or needle exchange programs without having to receive state approval (Rudavsky, 2017). His efforts have not, however, managed to convince everyone.

Map showing states with syringe exchange programs.

Source: HIV/HCV Co-Infection Watch

Madison County, for example, recently voted to remove all funding from their SSP, run by the county’s health department, and prohibited appropriations of funds for paying for both supplies and labor (Fentem, 2017). The ordinance, approved by five of the seven-person council, immediately shuttered the only operating SSP in the county, and was largely driven by stigma-based fears: discarded syringes were going to litter front lawns and public parks; drug addicts were going to wander over from neighboring counties, bringing their drug problems with them; “What about the innocent children?!” These well-worn excuses and arguments against the establishment and funding of SSPs have plagued the proven Harm Reduction measure since its inception. The fears are also unsupported by anything other than anecdotal evidence and hearsay, few assertions of which are backed up by any credible research or quantifiable proof.

Worse, still, is that the council members did nothing on their part to allay these fears. Council member Fred Reese is quoted as saying the following:

Some say if you don’t do the needle exchange, you’re going to have a spread of HIV, you’re going to have a spread of hepatitis C, but my concern is the innocents. I don’t want these needles out (Fentem).

This kind of statement on the part of an elected officials shows cowardice, rather than leadership. Part of the job of county councils is to do what’s in the best interests for everyone, rather than kowtowing to fear-based arguments that bear little resemblance to reality.

Clark County – where Scott County once sent its HIV cases for management – recently renewed their SSP for one year, after which it will be up for renewal in August 2018. About half of the program’s 150 participants have HCV, many of whom were diagnosed through the program (Beilman, 2017). Their hopes for the program include seeing a more balanced rate of return on needle collection. Of the nearly 16,000 needles distributed, the exchange collected almost 8,000 (Beilman).

In Boone County, where no SSP currently exists, Prosecutor Todd Meyer sent the following communique to county leaders:

A needle exchange program does not help in fighting the demand side, in fact, it will do the exact opposite by providing the users/addicts with the tools they need to continue to abuse illicit drugs…(Davis, 2017).

That this opinion was issued by a prosecutor should shock no one. Meyer’s position, however, is reflective of those espoused by [mostly Conservative] voters, legislators, and law enforcement officials, but again, bear little resemblance to reality. Instead, they rely upon fear and stigmatization, along with two terrifyingly short-sighted sentiments: “Not in my back yard!” and “It can’t happen here!” While Meyer contends that Boone County doesn’t have an HIV problem, now, let’s see if it has one in two years.

Back in Scott County, the SSP, run by the Scott County Health Department (SCHD), has another issue: it doesn’t keep track of HCV cases (de la Bastide & Filchak, 2017). For some reason, SCHD officials are only worried about their HIV problem. If that seems counterintuitive, that’s because it is. It was, in fact, a spike in new HCV cases that led to the discovery of the HIV epidemic. Additionally, with a 95% co-infection rate in the 216 HIV cases identified in the initial outbreak, as well as the more aggressive spread of HCV in the U.S. compared to HIV, it makes no sense, whatsoever, for the SCHD to fail to keep track of HCV.

The concurrent HIV and HCV outbreaks in Scott County, Indiana were just the beginning. Already, rural states and counties are beginning to see an uptick in new infections of both diseases as a result of Injection Drug Use (IDU). More concerning is the fact that most of those counties are deeply Conservative, which creates significant challenges for those hoping for proactive healthcare policies, rather than reactive cleanup measures. As for Scott County, there are several families with multiple generations infected with HIV, and very likely with HCV, as a result of prescription opioid and heroin abuse. Unfortunately for them, their county’s health department doesn’t see fit to track their issues.

Download the latest edition of the HIV/HCV Co-Infection Watch.

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

HIPAA: Healthcare mailers violate privacy rights of people living with HIV

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 came to light, last week, that Aetna – one of the largest health insurers in the U.S. – inadvertently revealed the HIV status of up to 12,000 clients by way of a mailer sent on July 28th, 2017 containing information about their options when they filled prescriptions for HIV medications. The notice was sent in the traditional envelopes sent by businesses, with the clear plastic window through which the letters “HIV” were clearly visible. The letters went out to people who are currently taking medications to treat HIV, as well as those taking Pre-Exposure Prophylaxis (PrEP), a regimen used to prevent the transmission of HIV (Kennedy, 2017).

Aetna mailer showing privacy violations.

In a similar incident, Ohio’s AIDS Drug Assistance Program (OhDAP), along with CVS/Caremark, sent out a similar mailer to roughly 4,000 clients containing their new “Insurance” cards, along with the full names, addresses, and the letters HIV above their names. In addition to that, the card provided inside the mailer contained ID numbers that included the clients’ date of birth, which creates the potential for identity theft (Hamilton, 2017).

Eddie Hamilton, who leads the ADAP Educational Initiative, was one of the victims of the privacy violations executed by OhDAP and CVS/Caremark. He provided a copy of the mailer to the HEAL Blog.

CVS/Caremark mailer showing privacy violations.

Both of these instances are a violation of Health Insurance Portability and Accountability Act (HIPAA), specifically Title II’s Privacy Rule, which regulates the use and disclosure of Protected Health Information (PHI), which prevents any information related to health status, provision of health care, or payment of healthcare that can be linked to an individual from being disclosed without the patient’s direct consent. These provisions were put in place in no small part because sensitive information, such as one’s HIV status, is something that can be used against individuals to deny access to certain benefits and jobs (which is also illegal under the Americans with Disabilities Act, or ADA), and/or have this information get into the hands of those who will use the patient’s HIV status against them in either a private or public manner.

What is most galling about these disclosures is that they were easily avoidable. While it is common business practice to use envelopes with clear windows in an effort to save a few cents per piece of mail, the relative savings compared to printing the address on a sticker and applying it to the outside of the envelope pale in comparison to the potentially high dollar amount in fines for each HIPAA violation, which can range from $100 to $50,000 per violation. And all to save a few centers per mailer.

Aetna, in response to their error, sent out a second letter informing customers of the privacy breach, and in a statement blamed an unnamed vendor for their failure to protect patients’ private health information. The letter was sent to customers in Arizona, California, Georgia, Illinois, New Jersey, New York, Ohio, Pennsylvania, and Washington, D.C. (O’Donnell, 2017). Attorneys for the Legal Action Center and the AIDS Law Project of Pennsylvania sent Aetna a demand letter that included a cease and desist order, as well as calling on Aetna to develop a plan of action to ensure that these types of incidents do not occur in the future (Legal Action Center, 2017).

Neither OhDAP, nor CVS/Caremark have made public statements regarding the disclosure of 4,000 clients’ HIV status. Additionally, the clients in question are those who rely solely upon ADAP funds to procure their medications, a program designed to help those who fall within a certain percentage of the Federal Poverty Limit (FPL) afford medications they might not otherwise be able to access. This means that these clients are less likely to have access to legal aid to help them redress the breach of their confidential PHI, and are less likely to know the appropriate steps to take in order to file HIPAA violation complaints with the Department of Health and Human Services (DHHS) Office for Civil Rights (OCR) or other state authorities.

One of the reasons why HIPAA is so vital for patients living with HIV is that it is their decision to disclose their HIV status, rather than that of healthcare workers, insurers, or any related businesses and partners. While certain areas of the U.S. tend to be more openly accepting about HIV status, other areas may be less than accommodating. Having one’s status revealed to family members, roommates, or friends without permission can have social repercussions, particularly in more religious areas of the country. It is difficult to overstate the severity of these breaches of confidentiality and privacy.

Beyond that, it is unclear whether the current administration’s OCR is going to take any actions against any of the offending parties, in which case patients and clients will have to resort to private or class-action suits against these organizations in order to properly address the situation. Normally, the OCR accepts settlements from offending parties, involving a lump sum payment and no admission of guilt (which is already assumed with the companies reveal that they’ve disclosed this information). HEAL Blog will continue to monitor these issues to see if any resolutions are met.

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

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:

__________

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

Navigating Patient Assistance Programs

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

Since HEAL Blog began publishing, we have striven to provide information about Hepatitis C (HCV) treatments, news, and issues surrounding the disease. We have also, on occasion, provided information related to Patient Assistance Programs (PAPs) that can help patients living with Hepatitis (HCV), HIV, or virtually any other illness afford the cost of their medications and treatments if they are unable to do so. Continuing along this line of thinking, today’s blog will be dedicated to three such organizations: NeedyMeds, the Patient Access Network (PAN) Foundation, and the Patient Advocate Foundation (PAF and NPAF).

Money flowing out of an open pill capsule

Photo Source: Chemistry World

NeedyMeds is a 501(c)(3) national non-profit information resource dedicated to helping people locate assistance programs to help them afford their medications and other healthcare costs (NeedyMeds, 2017a). They provide a NeedyMeds Drug Discount Card designed to lower the cost of prescription medications by up to 80% (NeedyMeds, 2017b). The discount card can be used cannot be combined with insurance or Medicaid/Medicaid drug coverage plans, but can be used in lieu of those plans to reduce the out-of-pocket costs of the medication. In some cases, using the NeedyMeds card instead of insurance may result in a lower cost to the patient than their insurance co-pay.

In addition, NeedyMeds’ website offers a variety of resources to help connect patients to other programs and organizations. These links include information pertaining to various drug-specific PAPs, a “Help with Paperwork” assistance service, a searchable database of both independent and manufacturer PAPs, and local resources to help patients apply for these programs (NeedyMeds, 2017c).

The PAN Foundation is an independent, national 501(c)(3) organization dedicated to helping federally and commercially insured people living with life-threatening, chronic and rare diseases with the out-of-pocket costs for their prescribed medications. Partnering with generous donors, healthcare providers and pharmacies, PAN provides the underinsured population access to the healthcare treatments they need to best manage their conditions and focus on improving their quality of life. Since its founding in 2004, PAN has provided more than 700,000 underinsured patients with over $2.5 billion dollars in financial assistance, through over 50 disease-specific programs. PAN has an administrative fee of only 5%. This means that $0.95 of every dollar PAN receives goes directly toward helping patients. For the last eight years, PAN spent less than one penny of each dollar it received on fundraising (PAN Foundation, 2016a).

The PAN Foundation has nearly sixty disease-specific assistance programs that help patients pay for out-of-pocket healthcare costs, including deductibles, co-pays, and co-insurance, travel expenses, and health insurance premiums, all of which are listed in a convenient, searchable database listed by condition (PAN Foundation, 2016b). This list also indicates the enrollment status of each program as Open (accepting applications for new and renewal patients), Renewal Only (accepting applications for renewal patients, only), and Fully Allocated (no longer accepting or processing applications for new or renewal patients). As of May 31, 2017, the programs for both HIV and HCV are open to new enrollees and renewals.

The Patient Advocate Foundation (PAF) is a national 501(c)(3) non-profit organization which provides professional case management services to Americans with chronic, life threatening and debilitating illnesses. PAF case managers serve as active liaisons between the patient and their insurer, employer and/or creditors to resolve insurance, job retention and/or debt crisis matters as they relate to their diagnosis also assisted by doctors and healthcare attorneys (PAF, 2012a). These services are vital to patients who may not be familiar with the complex workings of the American healthcare system (and let’s face it – most of us aren’t).

One of the primary goals of PAF (and their advocacy arm, National PAF – NPAF) is to reduce the financial burden by assisting patients in finding potential assistance that provide financial support for co-pays, discount and indigent drug programs, transportation, housing, food, utility shut offs, and by helping negotiate payment plans for treatment providers. They also assist patients by assessing eligibility and helping with enrolling patients in the various programs, as well as providing a baseline of employment-related support as needed.

As with all PAPs and independent and government programs, there are financial and other prerequisites that clients must meet in order to qualify. One of the biggest barriers to enrollment in co-pay assistance programs (both organizational- and manufacturer-funded) is enrollment in a government-funded healthcare program, such as Medicaid. Being enrolled in Medicaid generally disqualifies applicants from receiving assistance, even if the out-of-pocket expenses with Medicaid coverage are more than what patients can afford. There seems to be little “wiggle room” in PAPs that allow these patients to receive assistance, and this is a significant barrier that has yet to be addressed in any meaningful way.

Patient Assistance Programs are vital tools that can help patients afford the medications and treatments they need in order to survive. Moreover, they are resources that most patients, and even healthcare workers, rarely know about or reference, which makes them a potentially untapped source of aid in today’s volatile healthcare market. HEAL Blog will continue to monitor PAPs and to provide more information over time.

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

Heroin and Hepatitis Go Hand in Hand

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

Over the past year, HEAL Blog has paid a lot of attention to heroin, particularly in relation to the massive increase in heroin and prescription opioid overdoses in Appalachia, the Midwest, and the Northeast. While the purpose of HEAL – “HEAL” standing for “Hepatitis: Education, Advocacy, and Leadership” – is to specifically address issues related to Viral Hepatitis, and particularly Hepatitis C (HCV), when we cover issues related to prescription opioid abuse and heroin, we sometimes fail to connect the dots between the two topics. There is, in fact, a very high correlation between Injection Drug Use (IDU), People Who Inject Drugs (PWIDs), and the transmission of HCV: most new HCV infections in the three previously listed regions are related to IDU.

Sources of Infection for Persons with Hepatitis C

Photo Source: Pinterest

HCV and HCV-related co-morbidities (e.g. – Cirrhosis, Advanced Liver Disease) kill more Americans each year than any other infectious disease (Centers for Disease Control and Prevention, 2016). It is also one of the most expensive diseases to treat, with Direct Acting Agent (DAA) drug Wholesale Acquisition Costs (WACs) ranging between $50,000 and $100,000 for twelve weeks of treatment. This makes preventing the spread of HCV not only a matter of physical health, but one of fiscal health.

Despite pharmaceutical manufacturers’ arguments that the one-time cost of a regimen to achieve a Sustained Virologic Response (SVR – “cure”) is far cheaper than the long-term costs of other diseases, not to mention the long-term costs that arise if HCV goes untreated, state and Federal healthcare budget departments remain unconvinced. Budgeting processes generally focus on a single year, rather than accounting for multi-year spending, so arguing that long-term expenditures “cost” more hasn’t been an effective argument. Even with the clandestine pricing agreements and rebates – clandestine, because they are not made public due to “trade secrets” laws – states have yet to begin treating every HCV-infected client on their government-funded rosters. To do so would blow through entire pharmacy budgets several times over, in many states.

With PWIDs representing the highest number of new HCV infections between the ages of 18-35, state legislatures are starting to come around to the realization that the best way to avoid spending that money on expensive treatments is to put into place Harm Reduction measures that are shown to prevent the spread of blood borne illnesses. As it is very difficult and unfeasible to stop IDU, syringe exchanges can be put into place that allow PWIDs to inject using clean needles, rather than sharing them.

Syringe exchanges have, for much of the past forty years, been largely reviled by politically conservative politicians and states; many Republican politicians have repeatedly argued that state-sponsored syringe exchanges will only encourage bad behavior, serving as a tacit endorsement of IDU. Now that prescription opioid and heroin abuse has moved outside of the urban areas and into the suburban and rural areas that serve as bastions of the Conservative ideal, suddenly, these politicians are coming around to the idea.

Medical technician counting needles.

Photo Source: Daily Beast

In the past two years, several considerably conservative states have passed laws allowing syringe exchanges to be established – Indiana, North Carolina, Ohio, and Virginia, to name a few – largely in response to a relative explosion of new HIV and HCV infections related to IDU. The problems that politicians and their constituents once relegated to the big cities have come to their quiet towns, and have done so right under their noses. The lessons out of Scott County, Indiana, where nearly 200 people tested positive for HIV near the end of 2015 and into 2016, are still reverberating throughout the region, and people are starting to look at ways to prevent the spread of disease, rather than punish the behavior.

It is clear that the opioid and heroin abuse epidemic is not going away, anytime soon. Since we aren’t likely to stop currently addicted people from injecting drugs, the smartest path forward is to at least make certain they can do so safely.

References:

  • Centers for Disease Control and Prevention (CDC). (2016, May 04). Hepatitis C Kills More Americans than Any Other Infectious Disease. Atlanta, GA: 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

__________

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