HCV epi overview. Brigg Reilley, NPAIHB, Nat l Program Epidemiologist,

Transcription

1 HCV epi overview Brigg Reilley, NPAIHB, Nat l Program Epidemiologist, brigg.reilley@ihs.gov

2 In 20 minutes, we will cover Transmission/trends Screening HCV estimates: national, IHS, OK (federal), Cherokee

3 Disclosures My powerpoint formatting skills are truly apalling

4 Risk Factors for Transmission of Hepatitis C Injection Drug Use Blood Products Male-Male Sex Mother to Child Heterosexual Sex Needlestick Injury

5 Armstrong GL, et al. Ann Intern Med. 2006;144: ; Chak E, et al. Liver Int. 2011;31: Hepatitis C Prevalence (NHANES estimate) 3.2 Million HCV Antibody positive Possibly up to 7.1 Million HCV Antibody positive in US

6 NHANES Survey, United States, Awareness of HCV Infection Status Knowledge of HCV Infection Unaware of HIV infection 21% Source: Denniston M, et al. Hepatology. 2012:55:

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8 HCV Prevalence(%) NHANES Survey: United States, and Prevalence of HCV Antibody, by Year of Birth Year of Birth Source: Armstrong GL, et al. Ann Intern Med. 2006;144:

9 A 300% Increase in Hepatitis C related Hospitalization for AI/AN Byrd KK, et al Pub Hlth Rep 2011

10 HCV related mortality (CDC National Surveillance data, 2016) Rates nationally and among AI/AN dropped slightly from But rates remain the highest of all race ethnicities by far and double the national rate (10.75/100,000 among AI/AN, 4.45/100,000 nationally)

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12 OSDH recommends testing for the following persons: Anyone born from 1945 through Anyone who has injected drugs, even just once or many years ago. Anyone with certain medical conditions, such as chronic liver disease and HIV or AIDS. Anyone who has received donated blood or organs before Anyone with abnormal liver tests or liver disease. Anyone who has been exposed to the blood from a person who has Hepatitis C. Anyone on hemodialysis. Anyone born to a mother with Hepatitis C

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14 OK state data, 2015 acute HCV In 2015, a total of 92 cases reported and confirmed as acute HCV in Oklahoma. 53.3% of these cases were among males, while 46.7% were females. Age group years of age had the most cases and highest rates of all the diagnosed acute cases (21.7%). Whites made up 56.5% of the acute HCV cases were White. 80.3% of acute HCV patients reported having two or more sexual partners, while 62.5% reported using needles for street drugs

15 Chronic Hepatitis C Infection Disproportionately Affecting Oklahomans; OSDH Encourages Testing For Release: April 26, 2017 According to a newly released study, there are an estimated 94,200 Oklahomans living with Hepatitis C virus infection. Estimates were developed by researchers at Emory University in conjunction with the Centers for Disease Control and Prevention to better understand the number of people in each state living with Hepatitis C. The Oklahoma State Department of Health (OSDH) is encouraging residents to be tested for the virus as Oklahoma had the highest estimated prevalence in the nation at 3.34 percent, while the national prevalence was 1.67 percent. The report also indicates 523 Oklahomans died due to Hepatitis C from , ranking our state among the highest for Hepatitis C mortality.

16 Recommended Testing Sequence for Identifying Current Hepatitis C Virus (HCV) Infection - + Not detected - HCV RNA + Detected No HCV antibody detected No current HCV infection Current HCV infection STOP* Additional testing as appropriate Link to care * For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is recommended. For persons who are immunocompromised, testing for HCV RNA can be considered. To differentiate past, resolved HCV infection from biologic false positivity for HCV antibody, testing with another HCV antibody assay can be considered. Repeat HCV RNA testing if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical evidence of HCV disease, or if there is concern regarding the handling or storage of the test specimen. Slide courtesy AASLD Curriculum & Training Source: CDC. Testing for HCV infection: An update of guidance for clinicians and laboratorians. MMWR. 2013;62(18).

17 HCV Screening , IHS federal sites, persons born

18 Universal HCV Screening, Cherokee Nation From 8/16-12/17, the program screened 38,591 persons ages for HCV HCV Ab+ test reflexes to RNA confirmation

19 By Age Category (CNHS) 4.5% 4.0% % % 3.2% % 2.5% Percent Positive 2.0% Number Tested 1.5% 1.2% 1.0% % 0.0% Younger Baby Boomers Older 670 0

20 By Sex (CNHS) 5.0% 4.5% 4.5% % % % 2.7% % Percent Positive Number Tested 2.0% % 1.0% % 0.0% Men Women 0

21 HCV new diagnoses, IHS data

22 IHS HCV new dx by age group, , national Age (Years) Number (rate per 100,000) < (3.3) ,085 (67) ,302 (235) ,234 (496) 55+ 5,032 (199)

23 IHS new HCV dx by birth cohort, , national Birth Cohort Number (rate per 100,000) Born Before ,118 (101) Born ,900 (478) (Baby Boomers) Born After ,785 (105)

24 IHS new HCV dx by sex, , national No. (Rate/100,000) Sex Male 15,362 (193) Female 14,441 (166)

25 IHS new HCV dx by region , (national data) Region Number (rate per Rate Ratio, 95% P value 100,000) Confidence Interval Alaska 2,743 (179) 0.81 ( ) < East 1,051 (197) 0.89 ( ) Northern Plains East 1,875 (166) 0.75 ( ) < Northern Plains West 4,801 (224) 1.01 ( ) Southern Plains 7,986 (221) Reference Reference Southwest 5,538 (98) 0.44 ( ) < West 5,809 (286) 1.29 ( ) < Total 29,803 (179)

26 Cascade of Care, OK sites

27 Site 1 Site 2 Site 3 Site 4 Psite 5 Site 6 Site 7 Site 8 Comments HCV Ab Ab+, RNA neg No further clinical follow up needed Ab+, RNA unk Need RNA testing RNA Need to be cured RNA+ and Metavir Late stage disease need treatment ASAP RNA+ and Metavir 0-2 RNA+ and Metavir unk Need to have metavir calculated Currently in tx Treatment complete, SVR Treatment complete, SVR pending Cured. Excellent numbers

28 Summary OKC Area is doing well overall compared to other Areas, but each site needs support to address gaps in the Cascade of Care, namely Linking HCV patients to care for RNA testing and Metavir scoring Increasing number of HCV patients in treatment to cure existing patients in a timely manner

29 Barriers ranked by SUs SUs cited the main barriers to increasing HCV services as 1) needing more time to work on HCV clinical services, 2) contacting historical HCV patients to return to care for confirmation or treatment, and navigating the drug acquisition process.