The National Infrastructure for Hepatitis C: Is There Anyone Home? December 21, 2015

Transcription

1 The National Infrastructure for Hepatitis C: Is There Anyone Home? December 21, 2015

2 December 21,

3 December 21, Can we eliminate hepatitis C? Treatments

4 December 21, We Have the Roadmap Slide courtesy of NASTAD

5 December 21, We have the tools to prevent, test and cure! Slide courtesy of NASTAD

6 December 21, We Have the Guidelines

7 December 21, Significant Barriers to Elimination Lack of Funding for Public Health Services Lack of adequate surveillance infrastructure Drug Pricing Stigma Discriminatory Insurance Restrictions Congressional Ban on Funding for Syringe Access Programs Lack of Harm Reduction Services in Rural Areas Lack of Adequate Substance Use Treatment Access War on Drugs Need for Criminal Justice Reform Slide courtesy of NASTAD

8 December 21, Surveillance Infrastructure Insufficient resources for active hepatitis surveillance Only a handful of states funded for hepatitis surveillance activities Limited resources at the local level to follow-up and respond appropriately Current surveillance data Do not provide accurate estimates of the current burden of disease, Are insufficient for program planning and evaluation, and Do not provide the information needed to allocate sufficient resources to viral hepatitis prevention and control programs.

9 December 21, Surveillance Infrastructure Resources are needed to: Support a national hepatitis surveillance system Assess and monitor HCV incidence and prevalence Respond to and investigate emerging epidemics Clusters of HCV among Young PWID in non-urban areas HIV + MSM Healthcare related transmissions Support surveillance activities at the local level

10 December 21, Is $1 really enough to prevent hepatitis C?

11 December 21, Indiana Outbreak 11

12 December 21, HCV Prevention Must target PWID to prevent HCV transmission Harm Reduction and syringe access Not just syringe access/exchange Provide sterile drug preparation and injection equipment Expanded Syringe Access Programs END THE BAN ON FEDERAL FUNDS Ensure state and local policies support access to sterile needles, syringes and other drug preparation equipment Educate and train law enforcement Opioid Substitution Therapy Expand capacity for and access to OST Buprenorphine prescribed by PCPs Target young people abusing prescription opioids before transition to injection

13 December 21, HCV Prevention Co-locate HCV screening, counseling and linkage to care within programs serving PWID Develop effective interventions to reach young PWID Peer delivered syringe exchange Utilize social media, social networks Eliminate stigma associated with drug use HCV treatment as prevention Not one intervention alone will work Multi-prong approaches are needed Harm reduction + OST + HCV treatment

14 December 21, HCV Screening, Diagnosis and Linkage to Care You can t treat people for HCV if they don t know they have it Target screening in population with ongoing transmission(i.e., PWID) Target screening among those with highest morbidity and mortality HIV, Baby boomers Expand HCV screening to venues other than traditional health care settings CBOs, SEPs, mobile vans, homeless shelters, jails/prisons Utilize point of care rapid testing for hard to reach populations Enact state HCV testing laws Promote HCV reflex testing to ensure timely HCV diagnosis Require reporting of negative HCV RNA test results Active linkage to care efforts take time and resources

15 December 21, HCV Care and Treatment Systems for delivering HCV care and treatment are inadequate Patients cannot benefit from drugs they cannot afford Limited access to treatment within specialty clinics Integration of HCV prevention, screening/testing and treatment: Primary care settings Substance use treatment program Jails and prisons Need to build HCV knowledge and skills among primary care providers Tele-medicine; tele-mentoring Clinical guidelines targeting PCPs Clinical decision tools Quality measures

16 December 21, HCV Care and Treatment Educate and train PCPs to care for and treat marginalized populations, including PWID Establish case management and peer support programs to ensure adherence to HCV treatment Ensure providers are aware of pharmaceutical company patient assistance programs Establish programs and polices that ensure access to care and treatment for all Encourage state officials to prohibit insurance restrictions on HCV eligibility (e.g. minimum number of days sober, most advanced liver disease)

17 December 21, Community Mobilization Necessary to move HCV from an epidemic to elimination Lessons learned from HIV Engage the community into action by Listening, Building consensus, Identifying and working towards shared goals

18 December 21, Community Mobilization Strategic and meaningful alliances between: Communities, including those infected and affected Medical providers Public health Policy makers Meaningful community engagement must: Occur regularly, Consult a range of impacted stakeholders, Occur in a variety of venues and formats, Accommodate the needs and preferences of community members, Stretch our understanding and conventional wisdom and ideas about communities Occasionally make us feel uncomfortable

19 December 21, Example of Community Mobilization End AIDS NY 2020 Coalition, a statewide coalition of organizations and individuals committed seeing an end to the HIV/AIDS epidemic in New York.

20 December 21,

21 Percent of clients served Number of cases Reported number of acute hepatitis C cases United States, ,500 3,000 2,500 2,000 1,500 1, Centers for Disease Control and Prevention 100% Year NYSDOH HCV Care and Treatment Initiative 100% National HCV Cascade 80% 60% 40% 20% 0% 100% All infected Holmberg S, NEJM % 38% 23% anti-hcv HCV Care HCV RNA Treated 11% 6% SVR 80% 60% 56% 40% 35% 27% 24% 20% 0% Clients served Eligible for treatment Started Completed treatment treatment Achieved SVR

22 December 21, Eliminating HCV in NYS HCV programs have been built on a solid HIV infrastructure CDC-funded Viral Hepatitis Coordinator moved to AIDS Institute from communicable disease in 2006 State funding received since 2008 Contracts for HCV care and treatment Statewide HCV rapid testing program NYS HCV Testing Law- January 2014 Integration of HCV into drug user health and harm reduction programs Collaborations with NYS DOCCS HCV Continuity Program Review of DOCCS HCV polices and procedures Clinical guideline development Quality Indicator Program Partnering with Medicaid Community mobilization 22

23 December 21, HCV and HIV Approximately 15% to 30% of people in the U.S. with HIV are estimated to be co-infected with HCV HIV/HCV co-infected patients visit the emergency department more frequently, are hospitalized more often, and have longer hospital stays than HIV mono-infected patients Reduction and treatment of HCV transmission is a key priority for ensuring one devastating epidemic is not ended while another, which impacts many of the same populations, continues 23

24 December 21, BP Recommendations BP26: Provide HCV testing to persons with HIV and remove restrictions to HCV treatment access based on financial considerations for individuals co-infected with HIV and HCV. Reduce and treat HCV transmission Eliminate HCV-related morbidity and mortality among co-infected persons Address and remove restrictions to HCV treatment access BP15: Increase momentum in promoting the health of people who use drugs BP20: Expanded Medicaid coverage for sexual and drug-related health services to targeted populations GTZ3: Enact reforms to improve drug user health GTZ6: Expanded Medicaid coverage to targeted populations

25 December 21, Ending the AIDS Epidemic

26 December 21, Can We Eliminate Hepatitis C in the US? Increased Screening AND Confirmatory Testing Universal Access to HCV treatment Comprehensive Prevention Programs Prevention and Treatment Research Addressing Substance Use and Mental Health Addressing Social Determinants of Health Political Will, Leadership and Action Just like with HIV, it will be State by State based on Medicaid, the Affordable Care Act (ACA) and overall support

27 December 21, Slide courtesy of NASTAD

28 December 21, Dan O Connell daniel.oconnell@health.ny.gov