The Syndemics of HIV, Hepatitis, and Overdose

Transcription

1 The Syndemics of HIV, Hepatitis, and Overdose Sara Zeigler Associate Director for Policy Office of Policy, Planning and Partnerships (proposed) Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention USCA Hepatitis Pathway Session September 7, 2018 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Office of the Director

2 Massive Increase in Opioid Deaths in United States Over 600,000 people have died from opioid overdose since 2000

3 Acute Hepatitis C Infections Continue to Soar and Progress Combatting Hepatitis B is Threatened Over 22,000 Americans die of viral hepatitis each year 45,000 Estimated Number of Cases 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 Hepatitis B Hepatitis C 0 YEAR Source: National Notifiable Diseases Surveillance System (NNDSS)

4 Increased Transmission of Viral Hepatitis to Infants Without preventive treatment, 40% of infants born to HBV-infected mothers will develop chronic infection Without treatment, a quarter will die from liver disease From , HCV infection among women giving birth nearly doubled MMWR, May 12, 2017;

5 Hepatitis A Outbreaks in Multiple States CDC has been assisting with multistate hepatitis A outbreaks Primarily among homeless persons, persons who use injection and noninjection drugs, and their close contacts More than 5,118 cases; 63 deaths Over 3,058 hospitalizations

6 Drug Overdoses and Hepatitis C: Interconnected Epidemics Drug Overdose Death Rates Reported New HCV Infections SOURCE: CDC/NCHS Data Visualization Gallery 2016 SOURCE: CDC National Notifiable Disease Surveillance System

7 Annual HIV infections in the U.S. declined 15% from , then plateaued 50,000 45,000 40,000 45,200 15% One in 10 new HIV infections occur among people who inject drugs - - a decade of progress now threatened. 38,500 35, Prevented 34,000 cases at estimated cost savings for medical care of over $16 billion* Note. Estimates were derived from a CD4 depletion model using HIV surveillance data. *Farnham PG et al. Updates of Lifetime Costs of Care and Quality of Life Estimates for HIV-Infected Persons in the United States: Late Versus Early Diagnosis and Entry Into Care. JAIDS 2013; 64: Estimates updated to 2017 dollars.

8 WHAT WORKS?

9 Comprehensive Community Action Works Mobilize multi-sector community action health care education agencies public health law enforcement Comprehensive syringe services programs (SSPs) stopping use of drugs prevent infections link patients to treatment do not increase drug use or crime MacArthur BMJ Aspinall E J et al. Int J. Epidemiology, 2014; Turner Addiction 2011; Hagan J Sub Abuse Treatment 2000; Sypsa JID 2017

10 Targeted Disease Prevention Strategies Respond quickly and comprehensively to Hepatitis A clusters Implement targeted vaccination strategy Ensure Hepatitis B vaccines and testing are reaching the people who need them Increase screening, diagnosis, and treatment of Hepatitis C and reduce barriers to treatment access Cost of treatment is decreasing 2014: $83,000 $153, : About $40,000

11 Rapid and Comprehensive Outbreak Response Makes All the Difference 233 people with HIV ~90% had hepatitis C co-infection 5% adults with HIV (population 3,143) Over $100 million in lifetime medical costs Comprehensive community based prevention services worked Essential partnerships with law enforcement, schools, healthcare, and others Continued focus on adherence to treatment Credit: Tyler Stewart / Associated Press

12 44 states and Puerto Rico have areas that are experiencing, or at risk for, increases or outbreaks of HCV/HIV CDC Resource: Managing HIV and hepatitis C outbreaks among persons who inject drugs - A guide for state and local health departments

13 $478,000: lifetime cost to treat someone with HIV infection For every $1 CDC spent on HIV testing, $2 were saved in direct medical costs $6.5 billion: estimated total healthcare costs associated with hepatitis C infection in 2011 The average cost of curing people with hepatitis C is not only cost-effective, but cost-saving to the healthcare system

14 Comprehensive action will reduce drug use, save money, and save lives. Prevention of Harmful Opioid Use Prevention of Viral Hepatitis and HIV Treatment of Substance Use Disorder Linkage to Care and Treatment