World Hepatitis Day— today, July 28—brings awareness to the more than 400 million people across the globe who are infected with chronic viral hepatitis, including up to 150 million living with hepatitis C virus (HCV). In the United States, more than 3.5 million Americans—particularly baby boomers (those born between 1945 and 1965)—are living with HCV, making it the most common chronic bloodborne infection in the nation. With approximately half of HCV-positive individuals unaware they are infected, and increasing rates of new infection due to the escalating opioid abuse epidemic that is driving increases in injection drug use, HCV presents significant challenges to public health and healthcare systems.
In the face of this growing epidemic, there has been the advent of curative treatments for HCV; therapies that, unlike earlier interferon-based treatments, have shorter duration, few side effects, and high efficacy against all common HCV genotypes. The development of these curative treatments (called direct-acting antivirals, or DAAs) is truly a paradigm shift in HCV treatment, and opens a path to eliminating HCV both in the United States and across the globe. While elimination is a long-term goal, it begins with screening and yet many individuals who are at risk for HCV are never offered an opportunity to be screened. Even for those who have been screened and diagnosed, there are barriers to accessing treatment: the new curative therapies are expensive, insurance providers (including Medicaid) have placed restrictions on treatment access, and some physicians have been resistant to prescribing new treatments.
Local health departments (LHDs) are well-positioned to help address these barriers to treatment access, cure, and elimination. LHDs play a key role in educating local healthcare providers on the prevalence of chronic and acute HCV, on the current screening guidelines and the curative treatments now available, and on the populations in their communities most impacted by or at risk for HCV infection. LHDs are involved in policy-making and advocacy to increase treatment access by the removal of treatment restrictions that are not based on scientific evidence and that can be discriminatory. Additionally, LHDs have an important role in diagnosing and preventing new infections, through providing screening and linkage to care services, and implementing harm reduction efforts such as syringe service programs (SSPs) and naloxone distribution.
To ensure LHDs have the tools to engage in these activities, NACCHO developed the Hepatitis C and Local Health Departments Educational Series, a two-module series to increase LHD knowledge of HCV-related topics, provide information and examples of how LHDs can leverage existing resources to address HCV, and share successful LHD practices and policies for expanding HCV-related services in their communities. The first module, released in May 2015 to commemorate National Hepatitis Awareness Month, provides foundational insights into HCV and highlights:
- The epidemiology of HCV and advances in treatment;
- The National Viral Hepatitis Action Plan;
- CDC’s testing recommendations for persons born between 1945 and 1965; and,
- An example from the Philadelphia Department of Public Health about leveraging partnerships to address HCV.
Module 2, released in June 2016, shares methods for strengthening local capacity for HCV screening, diagnosis, and linkage to treatment through healthcare provider education, accessing populations at risk for HCV, and data collection and assessment. The module details approaches to planning, developing, and implementing practices and policies across the HCV prevention, care, and treatment continuum, and to establishing HCV as a local public health priority. The module highlights:
- Systems-based approaches and innovative strategies to collecting data to develop a local picture of HCV in your jurisdiction;
- Increasing antibody and RNA confirmatory testing for HCV;
- Reaching populations impacted by HCV in both traditional care settings and nontraditional environments; and,
- Participating in effective HCV policy-making and advocacy.
Both modules include multiple on-demand webcasts that range from 15 to 60 minutes, a discussion guide to facilitate conversation with health department staff around each webcast topic, and additional resources that help LHDs better serve community members infected with or at-risk for HCV.
Now that there are curative treatments for HCV, it is more important than ever to ensure everyone at risk for HCV is screened, and LHDs play a vital role in increasing screening and strengthening awareness of curative treatments. Be sure to check out the educational series, follow the latest viral hepatitis updates, and stay tuned for the release of our Hepatitis C Public Health Detailing Kit, which provides tools and resources to equip LHDs to educate and empower local primary care providers to address HCV.