In the U.S., hepatitis C virus (HCV) causes approximately 20,000 or more deaths a year and the rate of new HCV infections is increasing, fueled largely by the nation’s opioid epidemic. Since 2012, deaths from HCV have exceeded those from all other nationally reportable conditions combined, including HIV and tuberculosis. For these reasons, the U.S. National Academies of Medicine and the U.S. Department of Health & Human Services have declared eliminating viral hepatitis as a major public health goal.
There are an estimated 65,000 Washington state residents with chronic HCV infection. Chronic HCV puts an infected person at risk for serious liver disease, including cirrhosis, liver failure and liver cancer. Approximately 28% of these persons live in King County.
In 2014, Public Health was awarded a 5-year CDC grant (the Hepatitis C Test & Cure Project) to increase testing, evaluation and cure of persons with chronic HCV infection. Our partners for this work included the University of Washington, the Hepatitis Education Project, and six community healthcare system partners: Swedish Medical Center, Harborview Medical Center, Kaiser Permanente (formerly Group Health Cooperative), HealthPoint Health Centers, Neighborcare Health, and County Doctor Community Clinic).
We put systems in place to improve the identification and testing of persons at risk for HCV and to ensure those with chronic HCV infection are linked to care to check for liver disease and to receive antiviral medications to cure their infection.
As a result, we tripled the percent of at-risk persons tested and the number diagnosed with chronic HCV infection and increased the number of persons treated with curative medications 13-fold compared to the baseline before our project started.
The success of our 5-year grant-funded Hepatitis C Test & Cure project shows that tremendous progress towards elimination of hepatitis C as a public health problem is possible when adequate resources are available. However, our grant-funded program has come to an end. To achieve the ultimate goal of eliminating all forms of viral hepatitis in King County, Washington State, and the U.S., we need sustainable resources to ensure:
- Healthcare providers put systems in place to test all persons for hepatitis C according to current guidelines and ensure persons testing positive for hepatitis C receive appropriate evaluations for chronic liver disease and treatment.
- Robust public health reporting and data management systems to monitor the level of hepatitis C infections in the population and detect increases in infection rates promptly.
- Systems to link persons who test positive for hepatitis C to care and treatment.
- Widespread availability of medication-assisted treatment for persons with opioid use disorder and other measures to decrease the risk of infections from injection drug use, such as syringe exchange services.
- Integration of HCV care with other substance use disorder services.
- A comprehensive system of care and support for populations with hepatitis B & C on the scale of the support provided to people with HIV.
Published on 9/27/18