Hepatitis C Choices in Care Wellness, Healing, And Hepatitis C.
Mission and Vision Hepatitis C in Indiana Mission C... · Top Hepatitis C Risk Factors, by Percent*...
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10/24/2019 1 Hepatitis C in Indiana Deborah Nichols, MPH, MS Viral Hepatitis/Harm Reduction Program Director OUD ECHO Medical Co-Morbidity Sessions October 23, 2019 Mission and Vision Mission: To promote, protect, and improve the health and safety of all Hoosiers Vision: A healthier and safer Indiana How do you get it? Blood-to-Blood Hepatitis C is NOT transmitted How do you know you have it?
Transcript of Mission and Vision Hepatitis C in Indiana Mission C... · Top Hepatitis C Risk Factors, by Percent*...
10/24/2019
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Hepatitis C in Indiana
Deborah Nichols, MPH, MSViral Hepatitis/Harm Reduction Program Director
OUD ECHO Medical Co-Morbidity SessionsOctober 23, 2019
Mission and Vision
Mission:To promote, protect, and improve the health and safety of all Hoosiers
Vision:A healthier and safer Indiana
How do you get it?
Blood-to-Blood
Hepatitis C is NOT transmitted
How do you know you have it?
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Can it be treated or cured?Gelcaprevir and pibrentasvir
Mavyret
All genotypes
8 Weeks
$26,400
http://www.hepatitiswa.com.au/2017/08/01/new‐hep‐c‐treatments‐infographic/
$84,000‐$94,500
$94,500 $84,000 $83,320 $54,600
HCV Treatments
Generics now available for $24,500
What can happen if you don’t get it treated or cured?
How can you prevent others from getting it or giving it to others?
Abstain Be faithful
Choose Harm Reduction
Viral Hepatitis Surveillance
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26 people per day
in Indiana in 2018
received their first reactive HCV test
20 babies in Indiana
in 2018had a confirmed
surveillance case of
hepatitis C
13% 13% of all new cases of hepatitis C cases in Indiana in
2018 were identified in Department of Corrections
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119 140 181 236 359
1.82.1
2.7
3.5
5.4
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4.5
5.5
0
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100
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2014 2015 2016 2017 2018
Rate (per 100,000 population)
Case Count
Acute HCV Cases Acute HCV Rate
200% increase
72 acute HCV cases in 2018 were co‐infected with HAV
Acute HCV & incidence rate/100,000 population, 2014-2018 - Indiana
Indiana ranked #3 in US for Acute HCV in 2017
Chronic HCV & incidence rate/100,000 population, 2014-2018, Indiana
6025 6732 7896 8306 7783
91.3101.7
119.0124.6
116.7
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20.0
40.0
60.0
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120.0
140.0
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2014 2015 2016 2017 2018
Rate Per 100,000 Population
Number of Reported Cases
Year
Cases Rates
The Indiana Hepatitis C Iceberg, 2018
*Klevens RM, Liu S, Roberts H, Jiles RB, Holmberg SD. Estimating acute viral hepatitis from nationally reported cases. Am J Public Health. 2014;104:482‐487.
1 Reported
Acute Case1
12.3 Estimated
Acute Infections*
359 Reported
Acute Cases
4,415Estimated
Acute Infections
Combined acute/chronic incident HCV cases by year of birth, diagnosed in 2010 and 2018,
Indiana
0
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100
150
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350
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1920
1925
1928
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1994
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2000
2003
2008
2011
2016
Year of Birth
2010 2018
Baby Boomers Ages 18‐39
Top Hepatitis C Risk Factors, by Percent* – Indiana, 2014-2018
Hepatitis C Lab Reporting
Required• All positive screening
tests are reportable (antibody including rapid tests)
• All positive confirmatory tests are reportable (RNA, Genotype)
Desired• Pregnancy status for
women of child bearing age
• Bilirubin levels• ALT levels• Symptoms consistent
with VH• Negative antibody results• Negative RNA results
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410 IAC 1-2.5-75-76Increase in VH Program Staff
Irene Gonzalez
Hepatitis C Treatment
People who inject drugs represent a key population with the potential to sustain the HCV epidemic through continued transmission and thus SHOULD be targeted for treatment
Barriers to HCV Treatment for PWID
• At the patient level, misinformation about HCV and its treatment and the stigma related to substance use and HCV infection hinder linkage to care and limit patient interactions with the healthcare system
• At the provider level, misguided concerns about reinfection risk and adherence to HCV therapies
• At the system level, limited HCV treatment sites and restrictions on access to HCV therapy
Patient Level• At the patient level, innovative strategies are
needed to increase engagement in care for PWID. • Peer support by others who have experienced
substance use may be particularly effective at linking and supporting PWID through HCV treatment.
• HCV testing and linkage to HCV treatment in settings where PWID feel comfortable, potentially including sites where they currently access other services.
Provider Level• Trained non-specialists can independently
provide HCV treatment through ongoing collaboration using telemedicine platforms such as the Project ECHO model.
• It is critical to integrate harm reduction such as access to syringe programs into HCV care.
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System Level• Integrate HCV treatment into substance use
disorder treatment programs, public health clinics, syringe service programs, community-based organizations, and other sites providing services to PWID has the additional benefit of reducing barriers to HCV treatment.
• Innovative payment models at the system level may also improve treatment uptake..
*July 1, 2019 FSSA removed fibrosis restrictions for Medicaid patients for hepatitis C treatment
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Elimination!
To all the stakeholders in Indiana working to eliminate hepatitis!
Thank you
Deborah Nichols, MPH, MSViral Hepatitis/Harm Reduction Program DirectorDivision of HIV/STD/Viral [email protected]
