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Innovative Strategies for Addressing
Hepatitis C in Indian Country
March 14, 2016
Hepatitis C in Indian Country
Overview – Focus – Need
JESSICA LESTON, MPH
PROGRAMS MANAGER
[email protected]
[email protected]
907-244-3888
HCV Deaths and Deaths from Other Nationally
Notifiable Infectious Diseases,* 2003- 2013
* TB, HIV, Hepatitis B and 57 other infectious conditions reported to CDC
Holmberg S, et al. “Continued Rising Mortality from Hepatitis C Virus in the United States, 2003-2013”
Presented at ID Week 2015, October 10, 2015, San Diego, CA
Reported cases/100,000 population
Incidence of Acute Hepatitis C,
by Race/Ethnicity – United States, 2000-2013
2.5
2
1.5
1
0.5
0
00
0
2
2
0
20
4
0
20
6
0
20
American Indian/Alaska Native
Black, Non-Hispanic
Hispanic
8
0
20
10
0
2
12
0
2
Asian/Pacific Islander
White, Non-Hispanic
Year
Source: National Notifiable Diseases Surveillance System (NNDSS)
A 300% Increase in Hepatitis C –related
Hospitalization for AI/AN – 1995-2007
180
160
140
120
100
1995-1997
2005-2007
80
60
40
20
0
Overall
Male
Female
45-64 yrs
Byrd KK, et al Pub Hlth Rep 2011
HCV – Related Mortality by Race/Ethnicity
2007 compared to 2011
12
10
8
2007
2011
6
4
2
0
AI/AN
Black
Hispanic
White
Byrd KK, et al Pub Hlth Rep 2011
Good and Bad News
 The good news



Hepatitis C can be cured
Curing HCV reduces mortality and morbidity
Curing HCV reduces the risk of transmission
 The bad news

The HCV epidemic still remains invisible



Public/Medical providers/Policy makers
It is the infectious diseases with the highest mortality1
Access to treatment is complicated
 Good news again

WE CAN CHANGE THIS
Holmberg SD, et al ID Week 2015 San Diego
Slide courtesy Dr. Jorge Mera, Cherokee Nation
HCV Cascade
Chronic
HCV
Infection
3.5 million in United States
Diagnosed
and Aware
Access to Primary
Care
RNA
Confirmed
Case Management
RNA Tested
Workup
Case Management
Consultations
Prescribed
HCV
Treatment
Continued
Consultation
Drug Access
Achieved
SVR
Antibody Tested
Successfully Treated and Cured
Communication, Systems and Strategic Thinking,
Conflict and Change Management
HCV Screening persons born 19451965, IHS ALL
IHS highest SU: 72%
Total
2012
2013
2014
2015
8%
10%
25%
32%
mid
2016
42%
Best Practices
 EHR reminders
 Quick-picks and






automation
Standing orders
Clear delegation
Formal policy and training
Leadership
Partnership
Access innovations


PCC leads, pharmacy
Teleconsultation
Preliminary Epidemiology of HCV in IHS
 “Barbell” epi curve split between newly diagnosed
baby boomers with longstanding infection and
younger newly infected youth
 Younger HCV patients believed to be predominately
among injection use as per wider US (prescription
and opioids)
 Boomer seroprevalence range from 2%-12% in SUs >
50% screening
Simple, Effective, but out of Reach?
Where do we WANT to go?2016
Department of Veterans Affairs - Budget In Brief
Veteran Medical Care: Key Areas of Focus Obligations
($ in millions)
Caregivers
Hepatitis C (New Drug Treatments)
Women Veterans (Gender-Specific Care)
Mental Health
Telehealth
Rural Health Initiative
Homeless Programs
Activations
2014
Actual
350
379
380
6,676
986
248
1,521
659
2015
Estimate
482
697
412
7,106
1,098
250
1,445
548
2016
Estimate
555
690
446
7,455
1,224
250
1,393
598
2017
Estimate
642
660
482
7,715
1,372
250
1,393
598
Caregivers. VHA provides support to those individuals that act as a Family Caregiver for a
Veteran. There are several support and service options for the Caregiver. For example, the
Caregiver Support Line – 1-855-260-3274 – is available to: respond to inquiries about Caregiver
services, as well as serve as a resource and referral center for Caregivers, Veterans and others
seeking Caregiver information; provide referrals to local VA Medical Center Caregiver Support
Coordinators and VA/community resources; and provide emotional support.
The Program of Comprehensive Assistance for Family Caregivers, established in PL 111-163,
the Caregivers and Veterans Omnibus Health Services Act of 2010, has allowed VA to provide
additional supports and services to Caregivers of eligible Veterans injured in the line of duty on
REdesigned response to HCV is necessary
 Structural issues – policy, funding, legislation
 Cost of drugs
PAP successful, but require dedicated staff
 State Medicaid programs with ‘flat’ encounter rate

 Organizational issue – leadership, relationships
 Provider issues – training and education
 Patient issues – access, knowledge
 Innovation – rigor of development, adaptability
 Ethical implications – health equity and social
responsibility
Thank you
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907-244-3888