Urgent Response Needed to Eliminate Hepatitis C: A Call to Action

By Shanell McGoy July 27, 2017

I come from a family of public servants - policemen, firemen, nurses, military servicemen and women, and even activists - who worked towards achieving social justice. In fact, my fun loving, charismatic, and athletic Uncle worked towards integration as the first African American life guard at a public pool in our hometown. An excellent swimmer, he later enlisted in the United States Navy, served on the USS Hornet, and assisted in the recovery of the Apollo in the Pacific Ocean. Just last year my family said goodbye to my Uncle Barry who passed away from hepatitis C related complications. It is for Uncle Barry and all those living with hepatitis C that I Unite to End the Epidemics.  I am excited to announce NASTAD’s Call to Action for an Urgent Response to the Nation’s Hepatitis C Epidemic.

Hepatitis C Virus (HCV) kills more people in the United States than the other 60 nationally reportable infectious diseases combined including HIV, TB, and pneumonia. In 2015, there were an estimated 33,900 new HCV infections, a threefold increase in cases since 2010. Even with an under funded surveillance system, we know that states hardest hit by the opioid epidemic, such as Kentucky, Tennessee and West Virginia have seen a 365% increase in new cases of HCV, primarily in young people and women of childbearing age. Unfortunately, this has translated to drastic increases in infants born with HCV, for whom there is no FDA-approved treatment and there is no official case definition so these new infections are often being missed. The youngest among us are vulnerable and we must respond to the hepatitis C epidemic even more urgently.

Earlier this year the National Academies of Sciences, Engineering, and Medicine (NASEM) released the National Strategy for the Elimination of Hepatitis B and C: Phase Two Report that highlighted that we can eliminate hepatitis B and C as public health threats in the United States, and provides targets and recommendations for doing so. NASTAD’s Call to Action urges policymakers to prioritize hepatitis and devote more attention and resources towards a comprehensive response to reach the goals outlined in the NASEM report.

We have scientifically-validated effective prevention and care modalities that make ending this epidemic a real possibility within our lifetime. Comprehensive harm reduction services, including syringe services programs and medication assisted treatment, can reduce the risk of infection. Relatively low-cost screenings can rapidly identify people exposed to HCV, and most people living with HCV in the U.S. can be cured with 8-12 weeks of direct-acting antivirals—if they can access the medications.

Elimination of HCV is not possible without urgently focusing efforts toward the right people, in the right places, right now. This means implementing a strategy to prevent transmission within, and identification and treatment of hepatitis among, people who inject drugs (PWID). NASTAD’s Call to Action proposes the following set of recommendations to prevent new infections; reduce deaths and adverse health outcomes; address disparities; coordinate action among federal, state, and local agencies and health systems; and ultimately reduce health care costs:

  1. Focus on Prevention, Care, and Treatment for Priority Populations: The opioid epidemic is pervasive in rural, urban, and suburban America. HCV prevention, care, and treatment must be part of a comprehensive strategy to address the opioid epidemic. People of color, Native Americans, homeless individuals, incarcerated populations, veterans, and people co-infected with HIV and HCV are disproportionately impacted by HCV and need to be engaged in ending this epidemic.
  2. Address the Opioid Epidemic and Drug User Health: The most cost-effective strategy to prevent new HCV infections is to ensure a robust drug user health service infrastructure is in place in states and localities, and supported by federal resources.
  3. Screen, Diagnosis, and Link to Care: Efforts must be made to reach those most vulnerable for HCV by implementing screening and related services within the community, which often means outside of the clinical care setting. Improving hepatitis C surveillance by funding all jurisdictions is also critical.
  4. Treatment and Follow Up: In response to the high initial cost of direct-acting antiviral HCV medications, many private and public health insurance payers responded by restricting access to these relatively new medications to those with the most advanced disease and who were not actively using drugs. With elimination as the goal, treatment must be accessible and affordable to everyone, and especially those living with HCV who have been subject to discriminatory, arbitrary sobriety requirements.

Eliminating hepatitis C will require a significant financial investment. The Centers for Disease Control and Prevention’s (CDC) Division of Viral Hepatitis, which would lead these efforts, is currently funded at only $34 million, far below the $308 million for FY18 and $3.9 billion over ten years recommended by the CDC in a recent budget report. Policymakers and public health agencies at the federal, state, and local levels must prioritize hepatitis elimination efforts.

NASTAD’s vision is that new HCV infections in the United States are rare, and when they do occur, every person, regardless of substance use states, age, gender, race/ethnicity, sexual orientation, gender identity, disability, socio-economic status, incarceration status or geographic location, will have access to quality, affordable health care including comprehensive screening, care, and treatment leading to cure, without stigma and discrimination.

Our nation has a unique opportunity to not only eliminate a serious public health threat domestically, but to also become a leader globally. We owe the elimination of hepatitis C to people across our country, people like my Uncle Barry who honorably served our country. Although he is no longer with us, there are many others who are near and dear to us who can live if we adequately address hepatitis C. Let us respond more urgently to hepatitis C and unite to end this epidemics.

Download NASTAD’s Urgent Response to the Nation’s Hepatitis C Epidemic.