It is estimated that one in 30 baby boomers have hepatitis C virus infection and one in 12 Asian Americans and Pacific Islanders have hepatitis B virus infection. Still, a majority of the infected people in these at-risk populations are not aware of their infection. To raise awareness of these and other at-risk populations — including injection drug users and recipients of transfusions — the CDC launched multiple campaigns to encourage individuals to get tested and provided recommendations to clinicians for proper screening and treatment. However, barriers exist, blocking individuals from proper screening for infection.
“Outside of the research world, there are many factors that create barriers for hepatitis C screening,” Jorge Mera, MD, director of Infectious Disease, Cherokee Nation Health Services, told Healio.com/Hepatology. “I think a provider is often concerned to screen — for any diseases for that matter — if the clinician doesn’t know what to do with the results or if they don’t know of anybody to refer the patient. If they don’t have a specialist in their area to send the patient to, this can deter them from screening.”
Mera said that other barriers include, but are not limited to, the cost of medications, difficult populations to reach and the stigma of hepatitis.
“People tend to tie hepatitis C to drug use, which is true to a certain extent, but not 100% true,” adding that baby boomers born between 1945 and 1965 may have contracted the infection through not having disposable syringes or needles available as standard medical practice at that time. “But we don't know what the true vehicle was.”
“Everyone understands the rationale behind screening, but it depends on where you work as well. I think it’s doable, it just takes a lot of effort and time,” Mera said. “It is a recommendation to screen, but not mandatory so it depends on the institution or if someone really wants to take the time to make it happen.”
Michael Saag, MD, director of the Center for AIDS Research, University of Alabama at Birmingham, and Co-Editor in Chief of HCV Next, echoed Mera’s sentiments that if clinicians want to stop the spread of infection, they need the drive to overcome these barriers.
“We can’t treat and cure infections we don’t know exist,” Saag told Healio.com/Hepatology. “Yes, there are barriers to access to treatment, including high price of drugs and limited numbers of providers who feel comfortable treating the infection, but both of these issues are surmountable if we have the will and purpose.”
Catelyn Coyle, MPH, MEd, public health manager at the National Nursing Centers Consortium, Philadelphia, told Healio.com/Hepatology that she believes — in her experience and research — that primary care providers are starting a movement to implement on-site HCV screening.
“Speaking specifically for the providers I work with; I think most of us were surprised by how many patients have HCV, but from it, there has been a grassroots movement led by the primary care providers to build the capacity to treat HCV on-site, which would not have happened if we had not routinized HCV testing. This has also been great for patient care because it not only expedites patients through the cascade of care, but also allows patients to be treated by a trusted caregiver in a setting that has support staff to engage patients while they are going through treatment. I think another great discovery we have seen is how universal testing has destigmatized the disease since we test all patients over the age of 18 years.”
May is Hepatitis Awareness Month and May 19 is Hepatitis Screening Day. Healio.com/Hepatology composed a list of the latest studies that report increases in testing rates upon implementation of a screening program.
Collaboration improves HBV screening, linkage-to-care for Asians
Researchers from UC Davis Comprehensive Cancer Center engaged organizations in Sacramento County, California to link Asian populations to hepatitis B virus infection care. They found that more screening led to more linkage-to-care, in turn preventing spread of infection and liver disease.
“We created different campaigns to target each of the communities and came up with the best screening plan for the individual populations,” Julie Dang, MPH, director of community engagement and outreach at UC Davis Comprehensive Cancer Center, said in a press release. Read more
Julie Dang, MPH
Integrated HCV testing model successfully increases linkage-to-care
Researchers from the National Nursing Centers Consortium and Philadelphia Department of Public Health successfully implemented a routine hepatitis C virus infection testing model that increased testing and linkage-to-care among at-risk populations.
“Our project integrated HCV testing and linkage to care into routine primary care provided at five community health centers located in Philadelphia, Pennsylvania,” Coyle told Healio.com/Hepatology. “Patients served in these clinics represent subpopulations of Americans who are disproportionately impacted by the disease, including those living in poverty, the homeless, baby boomers and individuals reporting hard drug use history. These individuals are often the hardest to engage in continued medical care. Our model and results show that HCV testing in an underserved primary care setting can be integrated as part of routine care and successfully identify and link large numbers of HCV patients who may have gone undiagnosed until disease-related complications arise.” Read more
Cherokee Nation Health Services increase screening, treatment of HCV
After implementation of a tribal hepatitis C virus infection testing policy and Extension for Community Healthcare Outcomes telehealth program, the Cherokee Nation Health Services greatly increased screening and treatment rates.
“We were partly successful in our HCV screening because we set up the whole system from the get-go, meaning we had a case manager who procured medication and linked patients to care, so it was easy for me and the providers to screen,” Mera told Healio.com/Hepatology.
“For our study, we implemented the Extension for Community Healthcare Outcomes program, which was a blessing for us because I could train the providers and health professionals and testing rates increased by 500%,” Mera said, noting that this success can happen anywhere.
“It’s just a matter of getting stakeholders to the table, getting a plan and getting the clinicians and support you need to get it done. It’s all about clinical will at the end of the day to do this.” Read more
Jorge Mera, MD
Indian Health Service increases HCV testing rate fourfold
The Indian Health Service expanded its hepatitis C virus infection testing to the birth cohort 1945 to 1965 after the CDC recommended a one-time HCV testing for this population, which led to a fourfold increase in testing since 2012.
“This highlights the outstanding work that Indian Health Service facilities are doing to improve access to life-saving hepatitis C screening and quality medical care,” Susan Karol, MD, FACS, chief medical officer of Indian Health Service, told Healio.com/Hepatology. Read more
These studies point to progress being made in hepatitis screening, with hope that physicians can uncover carriers of hepatitis and move toward elimination of these diseases.
“A key cornerstone of eradication is the knowledge, true knowledge, of how many of our fellow citizens are infected and in need of cure,” Saag said. “This knowledge will provide needed energy and urgency to overcome the barriers of access and small number of care providers. We can’t fix what we don’t know exists.” – by Melinda Stevens
Disclosure: The researchers report no relevant financial disclosures.