Tag Archives: HIV

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

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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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Cherokee Nation Hospital Faces Questions About HIV, Hepatitis C 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

The Cherokee Nation in Tahlequah, Oklahoma is once again in the news, though now, for much less laudatory reasons. John Baker, the son of Principal Chief Bill John Baker, resigned from the tribe’s employ on May 1st, 2018, due to actions he took while performing his duty as a nurse at W.W. Hastings Hospital. During his time as a nurse, Baker used the same vial of medication and the same syringe to inject more than one IV bag (though no patients ever had direct contact with the needle).

If this sounds like an egregious breach of protocol, that’s because it is. Tribal councilman David Walkingstick stated in an interview:

“I hope that this was accidental, but Nursing 101, this is common sense. The other side of it is, was it intentional?  Was he out to harm people?  Or was he out to get the extra medicine?” (Newcomb, 2018)

As a result of his “lapse in protocol,” 186 people were possibly exposed to HIV and Hepatitis C (HCV). As of the June 18th, 2018 article detailing this exposure, 118 were tested, with no resultant infections being discovered (News On 6, 2018).

Cherokee Nation Medical Facility

Photo Source: KOTV News On 6

This incident comes on the heels of several positive evaluations of the Cherokee Nation’s efforts to combat the spread of HIV and HCV within the tribe’s borders, which we have covered twice within the past year. Despite these strides, the actions of Baker have sparked fears amongst its members. Native American tribes have, for several centuries, been the victims of various crimes committed against them by governmental and medical authorities, which has fostered a culture of distrust of medical providers within the members. How can tribe members be expected to trust going to W.W. Hastings Hospital if these kinds of “lapse[s] of protocol” – ones that are some of the very basic universal precautions taught to nursing students – are allowed to occur?

The Cherokee Nation has established a panel to investigate what happened, and more importantly, what happens next. If past exposure incidents serve as any indication, Baker may face any number of charges, many of which could be increased if any of the identified patients test positive for HIV or HCV. That said, because the Cherokee Nation has sovereignty – a Federally-recognized status recognized by treaty and law – there is a question concerning whether or not he will face state or Federal charges.

HEAL Blog will continue to monitor this issue and report as the story develops.

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 C Death Rate High Among Uninsured and Medicaid Recipients

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

Researchers presenting at Digestive Disease Week found that, between 2000-2010, adult who were infected with Hepatitis C (HCV) were more likely to die if they were either uninsured, or recipients of Medicaid benefits (Basen, 2018). Being HCV-Positive correlated with higher mortality rates (10.4% compared to 3.1% for HCV-Negative patients).

The limitations of these data are several – (a.) the data are nearly a decade old; (b.) these HCV mortality rates are from an era where the only curative treatments for the disease had a treatment abandonment rate of between 40-80%, because the Pegylated-Interferon treatments were almost impossible to tolerate; (c.) an artifact of those older treatments was that the Centers for Disease Control and Prevention (CDC) were not proactive about pushing HCV testing beyond the Birth Cohort (1945-1965).

While these data are nearing ten-years-old, they do reveal some interesting patterns that HEAL Blog has been contending for some time: (1.) Medicaid recipients were more likely to be infected with HCV than those with insurance; (2.) HCV infection rates were highest among the uninsured; (3.) HCV-Positive Medicaid recipients had higher rates of extra-hepatic (illnesses other than those affecting the liver) comorbid conditions, such as diabetes, congestive heart failure, and stroke.

Outpatient Medicaid Office

Photo Source: VinNews.com

Essentially, much like HIV, although neither disease discriminates against any class, color, or education level, those who are poorer, less educated, and minorities are disproportionately impacted by these fatal diseases. More to the point, there is no single rightway to deal with these issues; none of these issues exist in isolation:

  • less education correlates with and contributes to poverty, as well as leaving people less able to understand health risks and how to deal with any diseases they contract;
  • people who are impoverished tend to have less access to comprehensive (or even basic) healthcare services, and if they are poorly educated, they are less likely to utilize healthcare services, because they often don’t recognize symptoms of disease;
  • people who are have less access to healthcare services are likelier to develop chronic illnesses that prevent them from working, thereby increasing their likelihood of remaining in poverty.

Because these problems are interconnected, dealing with just one aspect is an ineffective approach – we cannot just address access to healthcare, because we’re not also addressing how people will pay for healthcare and treatment, nor are we considering the impact that accessing healthcare can have for people who have to miss hourly-wage jobs in order to access said care, and thus lose money, only to have to spend more money.

And, honestly, I don’t know what the answers in today’s America are. In a perfect world, we would have Universal Healthcare paid for by tax dollars that would low- to no-cost out-of-pocket, as well as expanded and affordable public transportation, higher wages, rent control, and free college and university paid for by taxes (like most of the rest of the modernized world). But, we don’t have those things, and it’s not likely we’re going to get those things any time soon.

In the meantime, looking at these data are a great way for us to craft policies to address these issues, particularly as new HCV infections are trending younger and younger, and younger people are less likely to be insured. Food for thought.

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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Efficacy of Syringe Services Programs in Preventing the Spread of HCV

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 two weeks, HEAL Blog has covered two separate counties within the state of California that have taken two very different approaches to dealing with access to Syringe Services Programs (SSPs) and the prevention of the spread of diseases such as HIV, Hepatitis B (HBV), and Hepatitis C (HCV).

This past week, Here and Now, a program produced by WBUR, Boston’s National Public Radio (NPR) station, has also been covering issues related to SSPs in a series of interviews. These interviews included:

  • Chelsi Cheatom, Program Manager for Trac-B Exchange in Clark County, Nevada, which established the nation’s first syringe vending machine in Las Vegas, NV (Here and Now, 2018b);
  • Ricky Bluthenthal, Professor of Preventative Medicine at University of Southern California, who studies the efficacy of these programs (Here and Now, 2018a);
  • Danny Jones, Mayor of Charleston, West Virginia, who has led a very vocal campaign against the county health department’s Harm Reduction Clinic (Here and Now, 2018c)

Each of these interviews provides a set of perspectives that are very important to the discussion of SSPs, their efficacy, and their existence in the U.S. – an academic perspective that researches these issues and argues that data show these programs to be highly efficacious; a program worker who can attest to the successes and challenges of these programs; an elected official who must deal with and respond to the outcry and fallout of the very existence of SSPs creates in local settings. While each of these perspectives are important, it is Mayor Jones’ take on the issues in Charleston, WV with which I take issue.

Mayor Jones has, for the past five months, been waging a war against Kanawha County’s Harm Reduction Clinic, and he has, unfortunately, won. As of May 14th, the Clinic is now officially suspended by the state of West Virginia in response to an audit requested by Jones and Interim Health Officer Dr. Dominic Gaziano. The reasons for the suspension, and the findings of the audit, indicate that the clinic failed to build and maintain community support, lack of data indicating that drug users were actually informed of other programs (including treatment and recovery services), insufficient evidence to support the safe recovery and disposal of needles, and insufficient evidence regarding the total number and types of referrals made to drug treatment programs (Takitch & Hoak, 2018).

Kanawha-Charleston Health Department

Photo Source: WV Metro News

I began interviewing the head of the Kanawha County Clinic in September 2017 regarding the successes and challenges of establishing SSPs in the state of West Virginia. This Clinic, in particular, faced significant challenges because it served as one of only two public SSPs that served clients from 9 southern WV counties (Boone, Cabell, Kanawha, Lincoln, Logan, Mason, Mingo, Putnam, and Wayne). Since our conversation, two addition clinics have opened, but they are further East, and stilldo not serve those communities.

To put this into better perspective, here are some frightening statistics regarding HCV in those counties:

  • The rate of new Acute JBV infections in the state of West Virginia is 14.6 (per 100,000) – the highest rate in the nation
  • The rate of new HCV infections in the state of West Virginia is a staggering 7.2 (per 100,000) – the highest rate in the nation
  • The rates of HBV and HCV infection for the aforementioned counties are as follows (WVDHHR, 2018):
    • Boone – (HBV) – 34.2; (HCV) – 0.0
    • Cabell – (HBV) – 17.6; (HCV) – 10.3
    • Kanawha – (HBV) – 29.2; (HCV) – 14.9
    • Lincoln – (HBV) – 56.0; (HCV) – 0.0
    • Logan – (HBV) – 17.3; (HCV) – 8.6
    • Mason – (HBV) 25.9; (HCV) – 0.0
    • Mingo – (HBV) 31.6; (HCV) – 7.9
    • Putnam – (HBV) 28.1; (HCV) – 3.5
    • Wayne – (HBV) 14.6; (HCV) – 0.0
  • The state of West Virginia has an overall drug overdose death rate of 52.0 (per 100,000) – the highest rate in the nation
    • Roughly 86% of those overdose deaths were opioid-related
    • WV has the highest rate over opioid overdose deaths in the nation, with a rate of 44.9
    • These nine counties have the highest rates of drug overdose deaths in the state of West Virginia

To say that the burden placed upon the Kanawha/Putnam Harm Reduction Clinic was high is a gross understatement. If you notice the rate of HCV being lower in some counties, it’s because the state only requires that physicians offer HCV testing to people in the Birth Cohort (born 1945-1965) unless the physician knows about another risk factor in a patient, meaning that patients are disinclined to say they inject drugs. So, HCV cases very likely exist, there, but physicians are not required to test for it on a regular basis, which is dumb, given the high rates of Injection Drug Use in those counties.

In addition to serving essentially nine counties, the Clinic had to do so on a shoestring budget, as state law prohibits the use of funds for specific drug-related expenditures. They had to secure funding for syringes and disposal on their own, meaning significant time was spent fundraising to pay for the very reason why they were there.

Additionally, the Clinic repeatedly requested funds for the purchase and installation of Biohazard Disposal Kiosks – steel, locked mailboxes into which sharps can safely be disposed. Each individual unit costs around $1,500, which includes the cost of purchase, shipping, signage, and installation. The county refused to fund these kiosks (which didn’t stop the Mayor and Police Chief from complaining about the additional biohazard sharps waste around the city), and they were only able to secure funding for a single unit – funding which came notfrom the health department budget, but from the Emergency Medical Technician budget, who were kind enough to supply the funds.

The arguments being made by Mayor Jones and the Police Chief are understandable – there has been an increase in needle waste in the city of Charleston and the surrounding areas…in no small part, because the city steadfastly refused to pony up the funds to install disposal kiosks in these areas.

Additionally, both men argue that the privately run facility – Health Right – is doing a better job of providing the service. Perhaps, this is because each client has to be enrolled and create a paper trail to participate? For anyone who’s ever worked with, done research about, or been around People Who Inject Drugs (PWID), the last thing they want to do is create a paper trail that authorities can use to follow them back to their homes and arrest them for illicit drug use, possession, and possession of paraphernalia. This is why the Kanawha facility had exponentially more clients than Health Right – they weren’t creating a paper trail.

Did the Kanawha/Putnam County Harm Reduction Clinic have its issues? Absolutely. The program operated for barely three years, and there will always be a learning period. But, thanks to the unreasonable efforts of Danny Jones, PWID in those nine counties now get to enjoy traveling even further to obtain clean supplies.

Mark my words – this is going to have a serious deleterious impact on the already-highest-in-the-nation infection rates in the state of West Virginia.

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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San Francisco: A Case Study in Multi-Pronged Approaches

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

One of the most frequent drums HEAL Blog likes to bang is that epidemics do not occur in siloes. As we learned in Scott County, Indiana, an uptick in new HIV and Hepatitis C (HCV) cases was largely the result of the Injection Drug Use (IDU) of the now-removed-from-the-market prescription opioid drug, Opana. The HIV community has been banging this drum since the 1980s; unfortunately, the politics around IDU were such that Syringe Services Programs (SSPs, or needle exchanges) simply weren’t a politically feasible reality in most of the United States. In other parts of the country, like San Francisco, underground exchanges began in the late-80s, and legalization was relatively quick to follow.

Needle exchange program with volunteers working with injection drug users

Photo Source: 5KPIX CBS

San Francisco’s first underground needle exchange – Prevention Point –  began in 1988 when a group of friends realized that something needed to be done to stop the spread of HIV among People Who Inject Drugs (PWIDs). Against California law, the organizers and volunteers went to great lengths to provide sterile syringes to PWIDs and also partnered with researchers, collecting data to document the positive health benefits programs like theirs could achieve (San Francisco AIDS Foundation, n.d.). Prevention Point operated for four years underground until 1992, when then-mayor Frank Jordan declared a public health emergency in the city of San Francisco and committed $138,000 to Prevention Point. This bold step went a long way to ensuring that SSPs were legalized within the state of California.

Fast-forward to 2018, and again, IDU is again a serious issue in San Francisco. This time, however, the San Francisco Department of Public Health is leading the charge using a variety of integrated initiatives involving:

opioid overdose prevention, education, and the distribution of Naloxone [an opioid overdose reversal drug]; access to and distribution of [sterile] syringes; prevention, screening, and treatment of HIV and HCV; alcohol prevention; and the creation of a Harm Reduction training institute (Chaverneff, 2018).

This multi-pronged approach to dealing with these intertwined epidemics using community-based methods, including peer education and testing models that have proven effective in other settings around the world.

More importantly, their model also includes taking HCV treatment outside of traditional healthcare settings, and helps to provide treatment at an Opiate Treatment Outpatient Program (at University of California San Francisco), at the San Francisco County Jail, at the SF AIDS Foundation Syringe Exchange program, at Magnet (a gay men’s sexual health clinic), at shelters, and in street settings (mobile setups). Of these, the most notable success was that the 10 patients who began HCV therapy in shelters all completed treatment; conversely, less than half of the 100 inmates who began HCV therapy completed treatment (Burk, 2018).

This model has been working for San Francisco, and it has the potential to work around the country, as well.

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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Trump’s War on the Poor is a War Against Us

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

On April 10th, current President, Donald J. Trump, fired the latest Republican salvo against the poor and social welfare programs by signing an executive order intended to force recipients of food assistance, Medicaid, and low-income housing subsidies to “get a job” or lose their benefits. A question that has yet to be answered is whether or not this edict will apply to recipients of Ryan White benefits, which provide low- or no-cost HIV medications, medical and dental treatment coverage, and other ancillary, yet vital services to an estimated 52% of people diagnosed with HIV in the United States (Health Resources and Services Administration, 2016). Those co-infected with Hepatitis C (HCV), whose cure requires treatment with some of the most expensive drugs on the market, are likely to be harmed, as well.

Make no mistake – this latest royal decr…executive order – unironically titled, “Reducing Poverty in America” – is specifically designed notto actuallypull people up out of poverty, but to force the “undeserving” off of the public dole. The order is directed at “any program that provides means-tested assistance or other assistance that provides benefits to people, households, or families that have low incomes” (Thrush, 2018). This is concerning for healthcare advocates, because the qualification for Ryan White services is predicated upon “means-tested assistance.” Essentially, how much money you make determines if you’re eligible for coverage.

Recent HCV incidence and prevalence reports indicate that an increasing number of new infectious occur in rural and suburban areas of the country, with higher rates of infection occurring in Injection Drug Users, particularly in people aged 18-45, and in areas where unemployment is high, educational achievement is lower, and access to healthcare services often faces several barriers. Essentially, HCV is prevalent among people and in places that are poor; people who often rely upon means-tested assistance to pay for healthcare.

As with virtually every Republican-initiated attempt to “reform” social services programs, this is a solution looking for a problem. Roughly 60% of working age, non-elderly Medicaid enrollees are working; plus, nearly 8 in 10 –  recipients (78%) live in families where at least one person works (Garfield, et al, 2018). The statistics are similar for recipients of the Supplemental Nutrition Assistance Program (SNAP)…  And for WIC…  And for virtually every other social safety net program.

76% of Louisiana's Medicaid expansion enrollees are working, caring for family members, or in school.

Photo Source: Louisiana Budget Project

Ryan White recipients, in particular, face an undue burden, as income requirements – particularly in more conservative states – are so low that working virtually any job will make them ineligible to receive coverage for medications that are prohibitively expensive. This will apply to both those mono-infected with HIV and co-infected with HCV.  For those receiving Medicaid, the burden will be just as high.

All of this stems from the Federal Poverty Level (FPL), a percentage of which determines eligibility for these means-tested programs. For an individual, the FPL is $12,140 per year in 2018. This means that an individual must make that amount, or less, to be considered “in poverty” in the United States. In states that expanded their Medicaid programs, most raised that qualification limit to 138% percent of the FPL ($16,753). The FPL percentage for Ryan White varies wildly from state to state.

This places potential recipients in a terrible position: At the current Federal Minimum Wage ($7.50/hour), an individual working 40 hours a week for 52 weeks will have an annual income of $15,080. If they cross this threshold by even a few hundred dollars, it makes them ineligible for the program, but still leaves them unable to afford the basic cost of living, much less any insurance premiums or medications they may have added to their monthly expenditures. Even with a second income, which would likely make them ineligible for services because they make “too much money,” the cost of living is so far removed from how the FPL is set, no person can reasonably expect to subsist off of that amount for any extended period of time in a First World country.

Adding work requirements to social programs also poses a logistical reality: simply demanding that “able-bodied” people “get jobs” doesn’t magically create jobs for there to be gotten. Nor are these requirements bolstered by any additional wraparound services, such as increased infrastructure spending to extend public transportation services out to far-flung locales, transportation assistance funds to cover the cost of fuel or low-cost public transportation passes.

The reality is that these “cost-saving” measures (ultimately designed to purge these programs of ‘undeserving’ recipients) will result in immeasurable costs that will be paid in human lives.

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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We Have a Cure for HCV; Few People Can Get It

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

Numerous films and novels have predicted this fate: there’s a fatal disease and someone invents a cure, but nobody can get it, and people die because of it. It’s a metaphor about the dangers of unchecked capitalism – the greedy owner of the cure who holds the rest of the world hostage until his demands are met.

And here it is – 2018, and we’ve had a cure for Hepatitis C (HCV) that’s easily tolerated since 2013, but it’s so prohibitively expensive that private and public payors, alike, have strictly limited access to it. They make patients, physicians, and pharmacists jump through as many hoops as possible to get the cure, from the strictest prerequisite abstinence guidelines, to allowing the disease to progress until it’s “bad enough” to cover it.

Medical Benefits Claim Form with the word, "REJECTED"

Photo Source: NPR

Sure, the cost of the newest drugs to cure HCV have dropped to ¼ of the introductory price of Sovaldi (Gilead), but, still – $30k for eight weeks of treatment? That’s still prohibitively expensive, even with the deep discounts and rebates given to many payors by manufacturers during the negotiation process. Those expenditures are only going to increase.

Now, there is evidence suggesting that undiagnosed HCV is more prevalent than undiagnosed HIV (Torian et al, 2018). Since the 1990s, hospitals and emergency departments have actively touted “routine HIV” screening, but have failed to deliver on those promises:

Lessons from HIV are both instructive and sobering: routine HIV screening is not truly routine; linkage continues to challenge even experienced providers; and linkage and treatment initiation vary widely across sites (Torian et al, 2018).

The findings from this study indicate not only a need to increase screening and linkages to care for HIV, but that this increase needs to be spread to HCV, as well. The latter argument, while correct, is unlikely to occur, in no small part because states and patients simply don’t have the resources to successfully implement this type of public health initiative.

Beyond just testing, minorities and Medicaid recipients – a significant portion of those infected with HCV – enjoy some of the lowest treatment rates in the nation (Wong et al, 2018). Hispanic patients were siginifantly less likely to receive treatment for HCV than white patients, and those on Medicaid, state insurance, or indigent care or no insurance were significantly less like to receive treatment than those with commercial insurance.

That last part comes to a head in rural America, where patients are far likelier to rely upon Medicaid as their primary payor for medical services, and where Injection Drug Use (IDU) of prescription opioids and/or heroin is high. In states like Ohio, Indiana, West Virginia, and Kentucky, IDU and rates of overdose go hand in hand with increased rates of both Hepatitis B and HCV.

The sad reality is that, given the existing political makeup of both state and Federal legislatures, it’s highly unlikely that the significant resources needed to effectively combat the spread of HCV will be allocated. At a time when budgets are being slashed in order to accommodate tax cuts for corporation and the wealthy, to suggest that conservative lawmakers are suddenly going to provide an exponential (or even incremental) increase in funding is unrealistic.

References:

  • Torian, L.V., Felsen, U.R., Qiang, X., Laraque, F., Rude, E.J., Rose, H., Cole, A., et al. (2018, April 04). Undiagnosed HIV and HCV Infection in a New York City Emergency Department, 2015. American Journal of Public Health 108, no. 5 (May 1, 2018): pp. 652-658. DOI: 10.2105/AJPH.2018.304321 Retrieved from: https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304321
  • Wong, R.J., Jain, M.K., Therapondos, G., Shiffman, M.L., Kshirsagar, O., Clark, C., & Thamer, M. (2018, March 09). Race/ethnicity and insurance status disparities in access to direct acting antivirals for hepatitis C virus treatment. The American Journal of Gastroenterology. DOI: 10.1038/s41395-018-0033-8. Retrieved from: https://www.nature.com/articles/s41395-018-0033-8

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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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