Tag Archives: HIV/AIDS

HIV/HCV Co-Infected Patients Show Similar Cure Rates As Monoinfected

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

Patients who are co-infected with both HIV and Hepatitis C (HCV) demonstrated similar cure (Sustained Virologic Response – SVR) rates as patients who were monoinfected with HCV, according to research published in Hepatology, a journal published on behalf of The American Association for the Study of Liver Diseases. These findings were gathered using a review of studies dated January 2004 to July 2017, and came to the conclusion that the designation of patients co-infected with HIV/HCV as a “special population” by the U.S. Food & Drug Administration (FDA) should be reconsidered, given the advent and increasing use of Direct Acting Antivirals (DAAs) to treat HCV.

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The special population designation by the FDA is designed to allow physicians and researchers to take into consideration populations who, for a variety of reasons – weight, existing disease morbidity, age, body composition, pregnancy, et cetera – may not respond in a typical fashion to standard treatment regimens. For patients living with HIV, many of the HIV-specific treatment regimens, until the past decade or so, made treating co-morbidities not HIV-related difficult, as other drugs would hamper or have their effects hampered by the medications used to treat patients’ HIV. The advent of newer, more easily tolerated, and more effective HIV medications has allowed for more flexibility.

Thus is the case with HIV/HCV co-infection. Prior to the entry of HCV DAAs to the market in 2013, interferon-based treatments were the only way to actively achieve SVR in HCV-infected patients. Notoriously difficult to tolerate and with a high treatment abandonment rate, interferon-based regimens resulted in very low SVR rates for both mono- and co-infected patients. This, along with the fact that co-infected populations experience accelerated progression of HCV-related liver disease, as well as existing barriers to care, led the FDA to designated HIV/HCV co-infected patients as a specific population with unmet medical needs.

The newer regiments, which are both easier to tolerate and exponentially more effective at achieving SVR, have produced similar SVR rates in both mono- and co-infected populations. This serves as good news to physicians and patients, alike. While these findings are welcome news, physicians must still be certain to determine if HCV regimens will have any counterindications with existing HIV therapies. Current treatment recommendations advise against stopping HIV therapy to pursue HCV treatment.

References:

  • Sikavi, C., Chen, P. H., Lee, A. D., Saab, E. G., Choi, G. & Saab, S. (2017, November 06). Hepatitis C and Human Immunodeficiency Virus Co-Infection in the Era of Direct-Acting Antiviral Agents: No Longer A Difficult to Treat Population. Hepatology. Alexandria, VA: The American Association for the Study of Liver Diseases. Accepted Author Manuscript. doi:10.1002/hep.29642

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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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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:

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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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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:

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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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The 2016 Election, and What This May Mean for Healthcare

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 passage of the Affordable Care Act (ACA), also known as Obamacare, included a provision that gave states the option to expand Medicaid coverage in order to cover citizens whose incomes were above the Federal Poverty Level (FPL), but whose incomes still present a significant barrier to purchasing health insurance. Of the 50 United States and the District of Columbia, 32 states (including DC) have opted to expand their Medicaid programs. Nineteen states have opted not to expand access.

Expanding access to Medicaid is an essential piece of the ACA, as it was designed to help increase the number of people with access to affordable healthcare. Because the ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for other coverage options. As a result, in states that do not expand Medicaid, many adults fall into a ”coverage gap” of having incomes above Medicaid eligibility limits, but below the lower limit for Marketplace premium tax credits (Garfield & Damico, 2016). Since the expansion of Medicaid under the ACA, 73,137,154 Americans were enrolled in Medicaid/CHIP as of August 2016 (Henry J. Kaiser Family Foundation, 2016).

There are an estimated 2.6 million Americans who currently fall into that coverage gap, and of the states that did not expand Medicaid, four states represent 64% of those people (TX – 26%, FL – 18%, GA – 12%, NC – 8%). When looking at the geographic distribution of those 2.6 million Americans, 91% are in the American South (Garfield & Damico, 2016). Demographically, 46% are White non-Hispanics, 18% are Hispanic, and 31% are Black, and over half are middle-aged (age 35-54) or near elderly (55 to 64). Additionally, the majority of people in the coverage gap are in poor working families.

Donald J. Trump

Photo Source: NBC News

President-elect, Donald J. Trump, as well as the incoming Republican-led Congress and Senate, have openly stated that their first priority, at the beginning of the next legislative session, is the repeal of the ACA. There are very few comprehensive plans being proffered to replace the ACA, and healthcare professionals, providers, payers, patients, and advocates, alike, are currently unsure about the future of the expansion, and whether or not that aspect of the ACA will be retained in the forthcoming repeal.

It bodes poorly for those existing people infected with viral hepatitis, especially Hepatitis C (HCV), who stand to lose coverage if the Medicaid expansion does not survive the repeal, even with the existence of drug manufacturer and private Patient Assistance Programs (PAPs). In order for those PAPs to be accessed, however, people must first know about them; without the aid of social workers, healthcare aides, and advocates, people living with HCV are unlikely to find out about these PAPs, unless this information is provided to them by a doctor or nurse.

An additional concern exists for those recipients of the Ryan White Program. Over the past eight years, HIV/AIDS advocates and policy wonks have been in a near-constant debate about whether to reopen the Ryan White Care Act for reauthorization to address some of the ways in which the current law has not necessarily aged well, in terms of keeping up with newer treatments, costs, and funding paradigms. The concern over the past five years has been that the Republican-controlled Congress would “gut” the bill, cutting out many of the provisions upon which organizations and patients have come to rely. With repealing the ACA having played such a large role in this year’s election, concerns about reopening the act are likely to deepen, rather than abate. It is important to note that many states include HCV therapies under their AIDS Drug Assistance Program’s drug formularies.

The HEAL Blog  will pay close attention to both programs, as well as other HIV and HCV-related issues throughout 2017.

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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Regimen Adherence and Abandonment

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 biggest concerns for healthcare providers when treating a patient for any disease is regimen adherence – whether or not a patient will properly adhere to a prescribed treatment or therapy. For example, one of the most common problems with the prescription of antibiotics to treat infections is patients who abandon the regimen once they begin to “feel” better, regardless of whether or not the entire prescribed amount has been taken. Early abandonment of drugs meant to treat conditions can lead to the bacterium or virus mutating to form a resistance to the drug, making resurgences more difficult to treat. When it comes to treating chronic diseases, such as HIV and Hepatitis C (HCV), these concerns are especially important, as treating resistant strains of these viruses can be incredibly frustrating, and may leave patients with few good options, drugs with more negative side effects, and costlier therapies than those used with patients whose strains have fewer drug resistances.

Pill Box with hand putting pills in Thursday's box

Photo Source: The Good Doctor, by Medica

The reality, however, is that there are some patients who simply are not likely to adhere to medication regimens; people for whom, for whatever reason, being compliant and doing things on a consistent basis is simply not in their skillset. My maternal grandparents exhibited this kind of reluctance to scheduled medication times. Regardless of how many day/night, week/month, or even time-released pill dispensers I gave them, they were simply unable to perform the appropriate task at the appropriate time, and often ended up taking double or triple doses of certain medications, until they were receiving truly dangerous levels of prescription medications. It took my mother and I essentially taking over my grandfather’s medications and wresting control from my grandmother to ensure that he was getting the right pills at the right time, when he was in his final months.

But, is there a better way to ensure regimen adherence without essentially doing it for a patient? Clinical specialty pharmacists and nurses at Johns Hopkins Medicine have demonstrated that there may be. They use a triage method to boost adherence rates, as well as the odds of successful outcomes, particularly for HCV, called the “stoplight protocol.” Before any costly specialty drug is ordered, patients presenting to the specialty clinic with newly diagnosed HCV infection are evaluated using a standardized screening tool and tagged with a stoplight color – green, yellow, or red – that indicates how well they understand the medication’s benefits and side effects, as well as how likely they are to stick to the regimen throughout the entirely of the treatment.

The patients’ designation also dictates the programmatic monitoring of HCV patients and how frequently the receiving nursing or pharmacist follow-up. Patients in the red zone for whom treatment is deemed appropriate may be monitored weekly, via either clinic visits or by telephone, while patients in the green zone are monitored far less frequently. This tight monitoring of patients’ regimen adherence has led to a therapy abandonment rate of just 4.2% for their HCV patient population, a rate comparable to the 1% – 4.5% discontinuation rate reported for patients in closely monitored HCV drug trials. In contrast, a 2014 “real-world analysis” conducted by the CVS Health Research Institute showed an overall abandonment rate of 8.1% for patients who were taking Sovaldi.

This type of approach looks to be a winning formula in a healthcare arena where specialty drugs to treat HCV run from $54k to $94k, before pricing agreements and rebates, and may be a key component in the treatment cascade that convinces state, federal, and private payers to lessen the often stringent pre-requisites for receiving treatment, especially if the favorable rates of abandonment reported by Johns Hopkins can be replicated at the state level. Perhaps the greatest struggle payers face is determining whether or not spending so much money on a potentially unreliable patient will be worth their investment, and as harsh as that sounds, when each prescription fill costs tens-of-thousands of dollars, it’s a determination that must be looked at for the continued solvency of pharmacy budgets.
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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.

 

References

 

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Intersection of Imprisonment and Healthcare

By: Marcus J. Hopkins, Blogger

“Nearly forty years ago, the U.S. Supreme Court ruled in Estelle v. Gamble that ignoring a prisoner’s serious medical needs can amount to cruel and unusual punishment, noting that “[a]n inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or a lingering death[.] … In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose” (American Civil Liberties Union, n.d.)

 

These words put forth in a Supreme Court ruling are vitally important in today’s society – one in which the Centers for Disease Control and Prevention (CDC) released its first ever National Survey of Prison Health Care, the results of which were rosy on the surface, but admittedly (on their part) limited in scope, because they only asked if the service was available, rather than checked to see if the services were actually delivered. In addition, numerous reports at the 2016 International AIDS Conference in Durban, South Africa point to a serious issue brewing in the world’s prisons, as the “War on Drugs,” mass incarceration of drug users, and the failure to provide proven harm reduction and treatment strategies has led to high levels of HIV, tuberculosis, and hepatitis B and C infection among prisoners—far higher than in the general population (Medical Express, 2016).

Two hands holding prison bars

Photo Source: News Limited

The U.S. is exceptional, when it comes to the number of inmates in prison for drug offenses: of the 182,924 inmates currently in Federal prison, 84,746 (46.3%) of them were there for drug-related offenses (Federal Bureau of Prisons, 2016). There are roughly 5 million drug-related arrests each year (Prison Policy Initiative, 2016), all of whom spend some portion of their time going in and out of the jail or prison population, which increases the risk of exposure to blood borne pathogens such a HIV, Hepatitis C (HCV), Hepatitis B (HBV), and Tuberculosis (TB) exponentially over that of the general population. As Injection Drug Users (IDUs) represent an ever-increasing percentage of new HCV infections in the U.S. and around the world, the risk of transmission amongst prison populations is an incredibly serious issue that needs to not only be watched, but addressed.

The unfortunate intersection of imprisonment and healthcare statistics is the reality of the HCV treatment landscape in our nation’s prisons. This has been brought into sharp focus, recently, by a Federal lawsuit against state prison officials in Tennessee, which asks the courts to force the state to start treating all inmates who have HCV (WBIR, 2016).. The Tennessean (part of USA Today) released a report in May 2016 finding that only 8 of the 3,487 inmates known to have HCV were being treated for the disease (Tennessean, 2016) – treatment to which these patients are constitutionally guaranteed, but for which few are ever approved. Further complicating the issue is that the number of HCV-infected inmates is likely much higher, but only a handful are ever tested, because “…acknowledging inmates have the disease means they must treat it.”

The lawsuit in Tennessee is just the latest in a string of Federal and class action lawsuits filed against state and Federal prisons over access to HCV drugs, which similar suits being filed in Pennsylvania, Massachusetts, and other states. Failure to adequately screen and treat all incoming patients for infectious diseases such as HIV and HCV is, in this writer’s opinion, a gross dereliction of duty on the part of prison officials that risks not only prison populations, but to all citizens at large, once those prisoners are released into general population. HIV and HCV that goes untreated is not only likelier to result to much more costly long-term health complications (and potentially death), but is also likely to result in greater overall infection rates, as untreated diseases are more easily spread from person to person.
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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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New Harm Reduction Focus Helps Bring Light

By: Marcus J. Hopkins, Blogger

The HIV/HCV Co-Infection Watch — published by the Community Access National Network (CANN) — recently added two new sections to its monthly report: the first focuses on the coverage offered by the Veterans Administration (VA); the second, and perhaps more involved research, focuses on Harm Reduction efforts.

HIV/HCV Co-Infection Watch

HIV/HCV Co-Infection Watch

The VA section is extremely cut and dry; they recently announced that they will effectively cover all veterans who are currently eligible for benefits for HCV treatment using Direct Acting Agent (DAA) HCV therapies. The Harm Reduction section, however, requires a more nuanced approach, as each state has its own interpretation of how they implement each aspect of Harm Reduction.

For those unfamiliar with the term, “Harm Reduction” is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use, as well as for expanding, protecting, and respecting the rights of drug users. The specifics, again, vary from state to state in their implementation, but there are overarching ideals that are used to shape these programs. In our research, we’re focusing on several very important Harm Reduction strategies:

  • Syringe Exchanges;
  • Expanded Naloxone Access;
  • Good Samaritan Laws;
  • Mandatory Prescription Drug Monitoring Programs;
  • Doctor Shopping Laws;
  • Physical Examination Requirements;
  • ID Requirements for Purchase;
  • Required/Recommended Prescriber Education; and
  • Lock-In Programs.

If this list seems exhaustive, it’s really only the tip of the iceberg. Harm Reduction strategies have a consistent track record of bringing about positive health outcomes, but little attention gets paid to them, unless there is a well-publicized health crisis – a sudden explosion of new HIV infections resulting from injection drug use, for example – that essentially forces the hand of state legislators to act. The most recent example of legislative Harm Reduction publicity came from Maine, which we covered two weeks ago, when Republican Governor Paul LePage vetoed a bill that provided expanded access to Naloxone by allowing it to be purchased from pharmacies without a prescription; his veto was quickly overturned by both Maine’s House and Senate on April 29th.

While Harm Reduction strategies have a proven record of net positive outcomes, there are always unintended consequences to any well-intentioned law. The U.S. has been in the throes of a prescription opioid addiction problem since the late 1990s, and state and federal governmental intervention is desperately needed and vitally important to help quell the ever-increasing addiction and overdose rates, HIV and HCV infection rates, and the unfortunate increase in criminal activities (such as varies classifications of theft) that tend to accompany an increase in opioid drug use. One such unintended consequence is the reduced access to prescription opioid drugs for patients whose healthcare needs truly necessitate their occasional use of a validly prescribed opioid.

I was recently asked by a very good friend if I knew of any doctors who would prescribe opioid pain relievers. This person knows the type of research I conduct, and his question stemmed from the fact that his doctor has repeatedly tried the same methods of pain relief that provide only short-term results to a chronic issue despite repeated requests to move past the less effective approach to a longer-lasting solution. My friend’s predicament is that any doctors outside of West Virginia University’s healthcare system are outside of his insurance plan’s network, which leaves him with few good options on a fixed income.

While I understand my friend’s predicament, I was unable to provide him with the answer he was seeking. What makes this problem difficult to address is that WV has one of the most vigorous legislative approaches to Harm Reduction strategies, largely because the state has been coping with a massive opioid addiction problem for at least two decades that has all but ravaged the state. It is my belief that this doctor properly using the context of WV’s opioid addiction problem to inform his overall approach to pain relief, and rightly so. For my friend, I suggested the use of a healthcare mediator or advocate during their next appointment; someone to speak on his behalf, and to try to come to a pain management approach that will allow him to better address his needs and to help the doctor understand his patient’s position – that the regimen he’s prescribing may not be the best solution for his patient.

My position, however, remains unchanged – Harm Reduction strategies are the most effective way to achieve net positive healthcare outcomes related to prescription opioid use, abuse, and addiction. While there will always be unintended consequences for some, the good of the many outweighs the complications that can arise from more stringent prescribing requirements. There is little doubt that we are facing a crisis of unprecedented scale; how we choose to deal with that, as a nation, will be of the utmost importance.

CLICK HERE to receive the monthly HIV/HCV Co-Infection Watch.
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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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