SCREENING AND TESTING POLICY
Keith Alcorn Published 27 April 2021 INFOhEP

Testing for hepatitis C among gay and bisexual men with HIV who are at higher risk of acquiring hepatitis C is falling short of recommendations, a study of a large US cohort of people in regular HIV care shows.
The findings are published in the journal Open Forum Infectious Diseases.
Hepatitis C can be cured by a short course of direct-acting antiviral treatment and the World Health Organization has set targets for testing and treatment coverage by 2030 with the aim of eliminating hepatitis C. Left undiagnosed and untreated, hepatitis C may eventually lead to liver damage or liver cancer.
Hepatitis C elimination partially depends on targeting groups of people with high hepatitis C prevalence, such as people who inject drugs and people with HIV, through intensified screening, linkage to care and treatment. This strategy, known as micro-elimination, has demonstrated strong progress towards elimination targets in some countries, notably Switzerland and Spain.
In the United States, up to 30% of 1.1 million people living with HIV are estimated to be co-infected with hepatitis C. It’s unclear what proportion remain undiagnosed. The US Centers for Disease Control and Prevention (CDC), the HIV Medicine Association and the National Institutes of Health recommended routine testing for hepatitis C in people with HIV in 2009. In 2015 CDC recommended that people with HIV should be screened annually if they were at high risk of acquiring hepatitis C.
There is little information about how well this guidance is being implemented in the United States, especially among people at higher risk of hepatitis C acquisition.
Investigators from the HIV Outpatients Study set out to analyse hepatitis C testing in their own cohort among gay and bisexual men with HIV. Ongoing sexual transmission of hepatitis C is especially concentrated among gay and bisexual men who are HIV positive, due in part to condomless sex between men with HIV.
The HIV Outpatients Study follows people with HIV receiving HIV care at nine clinics in six large US cities. This analysis looked at all gay and bisexual men receiving at least two years of care at a participating clinic between 2011 and 2019. It excluded people who inject drugs or people who had already tested positive for hepatitis C antibodies.
​TO CONTINUE READING: http://infohep.org/page/3549636/

MARCH 25, 2021  HEPVU

HepVu  spoke with Dr. Gregory Dore about the barriers to Hepatitis C treatment among people who inject drugs in the U.S. and Australia.

Gregory Dore, MD is a Scientia Professor and the Head of Viral Hepatitis Clinical Research Program at the Kirby Institute at the University of New South Wales Sydney in Australia.
Q: Your career focuses on Hepatitis C and other infectious diseases, especially among marginalized populations such as people who use drugs and people who experience homelessness. What led you to focus on these diseases and populations?
I worked in East Africa at a mission hospital in the early ‘90s before I completed my training in infectious diseases. I was involved in HIV care at St. Vincent’s Hospital in Sydney, Australia during the height of the AIDS epidemic in the early- to mid-1990s. During that period in Australia, HIV was predominantly affecting Gay and Bisexual Men and people who inject drugs.
During the ‘90s, in Australia and many other countries, Hepatitis C was mainly managed by liver specialists. My previous experience with HIV gave me a real passion for improving the lives of marginalized populations, such as people who inject drugs. I saw Hepatitis C as an opportunity because there weren’t a lot of people from infectious diseases and public health getting involved in that work during the mid-to late ‘90s. I set up the Hepatitis C services at St. Vincent’s Hospital in 1999 and began my professional journey in Hepatitis C research and clinical care.
Q: You recently co-authored a commentary on the barriers to Hepatitis C treatment faced by persons who inject drugs in the U.S., published in The Journal of Infectious Diseases. The paper states that barriers to Hepatitis C care exist at the “systems level, as well as the level of medical providers and patients.” Could you talk about these barriers and how they impact the Hepatitis C epidemic in Australia and the U.S.?
Australia is very different from the U.S. One of the key differences is that although Australia is a federation of states, there’s a lot of federal leadership and strategic direction in public health. There has been a bipartisan approach to support public health strategies, including fighting HIV and Hepatitis C. This collaborative approach enabled us to have a very public health-centered and nonpolitical approach to HIV prevention, starting in the ‘80s and ‘90s. A major component of this approach was broad harm reduction. Needle syringe programs with federal government funding were in place from the early ‘90s, a stark difference to the situation in the U.S.
In the U.S., federal funding has not been able to be used to purchase needles and syringes for harm reduction programs. Australia provided resources for these programs because we felt it was important to protect highly marginalized populations by reducing their individual risks while not judging people for their lifestyle. The lack of federal funding in the U.S. is a system level issue that affects prevention services and public health infrastructure. This infrastructure is crucial, especially when marginalized populations may not have access to routine healthcare.

​TO CONTINUE READING: https://hepvu.org/gregory-dore-hepatitis-c-treatment-barriers/?fbclid=IwAR3BTHORIp3G-p0PLvvc3CjtkFhR7QRwTq4Sn0FKSG4zk5RvMoVcKd3nBlU

The latest numbers surpass even the yearly tolls during the height of the opioid epidemic and mark a reversal of progress against addiction in recent years.

By Abby Goodnough April 14th, 2021 New York Times

WASHINGTON — More than 87,000 Americans died of drug overdoses over the 12-month period that ended in September, according to preliminary federal data, eclipsing the toll from any year since the opioid epidemic began in the 1990s.The surge represents an increasingly urgent public health crisis, one that has drawn less attention and fewer resources while the nation has battled the coronavirus pandemic.
Deaths from overdoses started rising again in the months leading up to the coronavirus pandemic — after dropping slightly in 2018 for the first time in decades — and it is hard to gauge just how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.
Many treatment programs closed during that time, at least temporarily, and “drop-in centers” that provide support, clean syringes and naloxone, the lifesaving medication that reverses overdoses, cut back services that in many cases have yet to be fully restored.
TO CONTINUE READING:https://www.nytimes.com/2021/04/14/health/overdose-deaths-fentanyl-opiods-coronaviurs-pandemic.html

By Abby GoodnoughBy Abby Goodnough

PBS NEWSHOUR
SALEM, Ore. (AP) — Police in Oregon can no longer arrest someone for possession of small amounts of heroin, methamphetamine, LSD, oxycodone and other hard drugs as a ballot measure that decriminalized them took effect on Monday.
Instead, those found in possession would face a $100 fine or a health assessment that could lead to addiction counseling. Backers of the ballot measure decriminalizing hard drugs, which Oregon voters passed by a wide margin in November, hailed it as a revolutionary move for the United States.
“Today, the first domino of our cruel and inhumane war on drugs has fallen, setting off what we expect to be a cascade of other efforts centering health over criminalization,” said Kassandra Frederique, executive director of the Drug Policy Alliance, which spearheaded the ballot initiative.
Ballot Measure 110’s backers said treatment needs to be the priority and that criminalizing drug possession was not working. Besides facing the prospect of being locked up, having a criminal record makes it difficult to find housing and jobs and can haunt a person for a lifetime.
Two dozen district attorneys had opposed the measure, saying it was reckless and would lead to an increase in the acceptability of dangerous drugs.
Instead of facing arrest, those found by law enforcement with personal-use amounts of drugs would face a civil citation, “like a traffic ticket,” and not a criminal citation, said Matt Sutton, spokesman for the Drug Policy Alliance.
Under the new system, addiction recovery centers will be tasked with “triaging the acute needs of people who use drugs and assessing and addressing any on-going needs thorough intensive case management and linkage to care and services.”
The addiction recovery centers will be funded by millions of dollars of tax revenue from Oregon’s legalized marijuana industry. That diverts some funds from other programs and entities that already receive it, like schools.
TO CONTINUE READING: ​https://www.pbs.org/newshour/politics/oregon-1st-state-to-decriminalize-possession-of-hard-drugs

April 03, 2021 | by Phara Souffrant Forrest, Karines Reyes & John T. McDonald ​ -GOTHAM GAZETTE THE PLACE FOR NEW YORK POLICY AND POLITICS

As health-care professionals we know COVID-19 is unprecedented, but as legislators we know budget cuts are not. Despite the immeasurable impacts of COVID-19, Governor Cuomo’s Fiscal Year 2022 Executive Budget proposes cuts to critical health-care funding for New York State. Our experience in health care makes us uniquely attuned to the disproportionate impact that this budget would have on low-income and working class New Yorkers. As we plan a recovery for COVID-19, we cannot turn our backs on the very workers that made sure our state functioned during a global pandemic. As we come to a final agreement on an adopted budget for the new fiscal year, New Yorkers need an equitable budget that prioritizes public health and implements proactive practices to respond to future health emergencies.
Since the first reported case of COVID-19 in New York, nearly 40,000 New Yorkers have died after contracting the virus. Rather than continuing to do business as usual, we must transform our approach to public health to prioritize culturally-competent and population-specific care. New Yorkers are unique; a one-size-fits all approach to health care will no longer suffice. Over the past year, it has become exceedingly clear that in the face of a global pandemic, underlying health inequities are life-threatening for certain populations.
For decades, Article 6 programs have been providing a range of life-saving, hyper-local, community-centered programs to specific populations, promoting public health, and addressing concurrent health epidemics, including HIV and the opioid crisis. While on the front lines, we witnessed the immense impact of Article 6 funded programs on individuals that would otherwise go without essential care. It is unfathomable that this funding be jeopardized, especially during a global pandemic.
It is in this spirit that we advocate for the adopted budget to invest in a just recovery for New York and the continued health of New Yorkers by increasing Article 6 reimbursement rates in five boroughs of New York City to 36%, the same rate as other New York State counties. At the very minimum, reimbursement must continue at 20%; anything less would disproportionately affect communities that have been hardest hit by COVID-19 and are already struggling to regain some semblance of their overall wellbeing. 

​TO CONTINUE READING: https://www.gothamgazette.com/opinion/10343-legislators-healthcare-state-budget-jeopardize-covid-19-recovery-public-health

​Zachary Siegel/March 15, 2021

 The sudden overdose deaths of Philip Seymour Hoffman and Prince, in 2014 and 2016, happened during wall-to-wall coverage of an emerging crisis, which had come to be known as the “opioid epidemic.” A 60 Minutes investigation in 2015 titled “Heroin in the Heartland” was premised on heroin’s changing profile. “The faces of heroin include the young, middle-to-upper class and suburban,” the synopsis reads. “What was once thought of as an inner-city problem is now a national epidemic.”

Major media outlets each did their own version of the “new face of heroin.” That new face was young, white, and “all-American.” In the 2000s, many cases of addiction to heroin began with pharmaceutical opioids that had flooded the market since the late 1990s, thanks in large part to toothless regulators captured by corporate interests. A glut of high-dose opioids like oxycodone flowing through the medical market found a young, white consumer base in the illicit market willing to pay top dollar. But things took a dark turn around 2010, when pharmaceutical opioids became scarce, expensive, and tamper-proof, which sparked a mass exodus from pills to cheap, potent, and widely available heroin. Some experts thought a “rush” to the heroin market wouldn’t be all that bad, but since the crackdown on pharmaceutical opioids, overdose deaths continue to break annual records. Thousands died because they were now using drugs in an unregulated, criminalized environment.

But because pharmaceutical opioids were pinned as the gateway to heroin addiction—even though many heroin users were never prescribed opioids themselves--the media did not demonize these new users as “junkies.” This “new face” narrative also posited that drugs like heroin were leaving “urban” centers and invading America’s idealized heartland, places like the Ohio River Valley and Appalachia, where drug use and addiction do not belong (aside from alcohol, of course).

TO CONTINUE READING:
https://newrepublic.com/article/161692/america-segregates-drug-use?fbclid=IwAR1Uhvx7vsdbp4H2ktE03-2aC4kEYuR1eskGYXpL5-bfKZTJ_ioaoLd44Fk

Exciting news !

EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF NATIONAL DRUG CONTROL POLICY
Washington, DC 20503
 

FOR IMMEDIATE RELEASE:
Wednesday, March 10, 2021
CONTACT:
Press@ondcp.eop.gov

 
ONDCP Statement on the Final Passage of the American Rescue Plan Act

 Congress delivers nearly $4 billion for substance use disorder and mental health

 Washington, D.C.—Today, Regina LaBelle, Acting Director of National Drug Control Policy, released the following statement upon the House of Representatives’ final passage of the American Rescue Plan Act:
 
“The COVID-19 pandemic has strained American society and the effects on people with substance use disorder have been considerable. President Biden has been calling for record investments for addressing addiction since before he took office, and today, Congress made the down payment by passing the American Rescue Plan Act. This funding will help expand access to substance use treatment and prevention services, addiction workforce training, community behavioral and mental health services, including syringe service programs, and much more. ONDCP looks forward to continuing to work with Congress to bend the curve on the overdose epidemic and save lives.”
 
Specifically, President Biden’s American Rescue Plan will provide:
 

• $1,500,000,000 in funding for block grants for community mental health services.
• $1,500,000,000 in funding for block grants for prevention and treatment of substance use disorders.
• $80,000,000 in funding for mental and behavioral health training for health care professions, paraprofessionals, and public safety officers.
• $20,000,000 in funding for education and awareness campaign encouraging healthy work conditions and use of mental and behavioral health services by health care professionals.
• $40,000,000 in funding for grants for health care providers to promote mental and behavioral health among their health professional workforce.
• $30,000,000 in funding for community-based funding for local substance use disorder services like syringe services programs and other harm reduction interventions.
• $50,000,000 in funding for community-based funding for local behavioral health needs.
• $10,000,000 in funding for the National Child Traumatic Stress Network, which works to raise the standard of care and increase access to services for children and families who experience or witness traumatic events. 
• $30,000,000 in funding for theSubstance Abuse and Mental Health Services Administration’s Project AWARE (Advancing Wellness and Resilience in Education), to address mental health issues among school-aged youth.
• $20,000,000 in funding for youth suicide prevention.
• $100,000,000 in funding for behavioral health workforce education and training.
• 80,000,000 in funding for pediatric mental health care access.
• $420,000,000 in funding for expansion grants for certified community behavioral health clinics.

 
White House Office of National Drug Control Policy |WhiteHouse.gov/ONDCP | @ONDCP 

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By Usha Lee McFarling Feb. 16, 2021 STAT
Reprints

Among the unrelenting death statistics flowing from the CDC last month, one grim non-Covid-19 statistic stood out: 81,003 deaths. That’s the number of people who died from drug overdoses in the 12-month period ending last June: a 20% increase and the highest number of fatal overdoses ever recorded in the U.S. in a single year.
The drug deaths started spiking last spring, as the coronavirus forced shutdowns, and more recent statistics from cities throughout the U.S. and Canada show the crisis has only deepened. In Colorado, overdose deaths were up 20% through the end of last year, and those involving fentanyl doubled; British Columbia officials reported nearly five overdose deaths per day in 2020, a 74% increase over the previous year; and a study released this month showed emergency room overdose visits increased up to 45% during the pandemic, even as total ER traffic slowed markedly.
The pandemic has ushered in stress, isolation, and economic upheaval — all known triggers for addiction and relapse — while robbing many people of treatment options and support systems. Addiction specialists across the country told STAT the overlapping health disasters — the historic Covid-19 pandemic colliding with a preexisting drug epidemic made deadlier by the potent synthetic opioid fentanyl — have been devastating for their patients. Many have simply disappeared; some have died; others have relapsed.
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“There’s all of these ways Covid-19 has hurt the folks we take care of,” said Stephen Taylor, a psychiatrist and addiction specialist in Birmingham, Ala., who serves as chief medical officer of the behavioral health division of Pathway Healthcare. “Efforts to get this under control have really been decimated by the pandemic.”
Taylor described a patient who spoke only Spanish and had been doing well in recovery from opioid addiction for several months. “He’d found this excellent all-Spanish AA meeting. But that group wasn’t able to go online,” Taylor said. “That guy was all of a sudden without his 12-step group, and he relapsed.”
The increase in opioid deaths is crushing to those who work in public health and addiction treatment, who were finally making headway, thanks to growing public attention and government funding. Overdose deaths had fallen in 2018 for the first time in years. But the spread of fentanyl began to erode those gains, and now the pandemic has severely undercut efforts to control the opioid epidemic; with public health officials focused so heavily on the coronavirus, suffering and death due to substance abuse has largely fallen off the radar.

TO CONTINUE READING: https://www.statnews.com/2021/02/16/as-pandemic-ushered-in-isolation-financial-hardship-overdose-deaths-reached-new-heights/?fbclid=IwAR0hf4_PgPriFjAp1kNcFjqaAmRgQw3onaXoJNqARRar50TpazTTokdjkGI

​In this HepVu Q&A, Frank Hood of The AIDS Institute explains the need for viral hepatitis elimination and the logistics behind budget negotiations.

Frank Hood is the Manager of Hepatitis Advocacy for The AIDS Institute.

Q: What brought you to Hepatitis C advocacy and can you describe your work at The AIDS Institute? How do viral hepatitis efforts fit in with AIDS Institute’s advocacy on HIV?
I’ve been fortunate enough to spend my career helping people access better healthcare, safer workplaces, and stronger communities. I started working in the implementation of the Affordable Care Act (ACA), which solidified my focus on public health and how it affects not only individuals, but also entire communities. As I advanced through my career and the opportunity with The AIDS Institute around Hepatitis C came up, I realized that we were just resources and dedicated personnel hours away from eliminating this infectious disease – and jumped right in.
Working in the progressive and LGBTQ community gave me experience with the impact of HIV, so working with an issue directly tied to HIV is another big reason I moved into the viral hepatitis space. We can’t talk about HIV health unless we also talk about viral hepatitis health. About a third of people living with HIV in the U.S. are also co-infected with viral hepatitis, either Hepatitis C or B. Persons with HIV and viral hepatitis have worse health outcomes than those persons who have viral hepatitis but are not infected with HIV.
At The AIDS Institute, we advocate a syndemic approach to viral hepatitis elimination by leveraging not only best practices, but also the existing public health infrastructure for HIV, STDs, and other infectious diseases. For example, if someone gets an HIV test, they should get tested for viral hepatitis at the same time.
In addition to screening, there are connections within HIV treatment programs, such as the Ryan White HIV/AIDS program, to provide viral hepatitis care for co-infected patients. Viral hepatitis advocates also keep updated on the U.S. Department of Health and Human Services (HHS)’ Ending the HIV Epidemic: A Plan for America (EHE) plan, because it provides an infrastructure framework that can also positively impact viral hepatitis in the country by expanding provider locations and scope of programs to attract people living with viral hepatitis. The AIDS Institute and various viral hepatitis organizations will participate in advocacy days with other infectious disease groups to work together, because these diseases are very much intertwined. There is a huge syndemic focus on these diseases, including injection drug use and lack of sterile injection equipment.
Q: What is the current landscape of viral hepatitis funding in the U.S.? How does it compare to other diseases, and has it been impacted by the COVID-19 pandemic?
The current funding landscape for viral hepatitis in the U.S. is abysmal – but improving. We have had some success generating additional funding from Congress over the last four or five fiscal years, but it is still dramatically less than what we need.
The Centers for Disease Control and Prevention’s Division of Viral Hepatitis received core prevention and surveillance funding of less than $40 million in fiscal year 2021. According to experts, the CDC needs nearly ten times that amount to put the U.S. on a path toward elimination. Viral hepatitis funding is significantly lower than dedicated funding for other infectious diseases, and that must be increased to effectively mount an elimination campaign. We urge Congress and the administration to do that in conjunction with funding to combat the opioid crisis, because the increasing incidence of Hepatitis C is directly tied to injection drug use and lack of sterile injection equipment.
We also urge Congress to bolster funding for the entire public health system, because a stronger system will help identify and contain viral hepatitis outbreaks, and to take a syndemic approach that allows state and local programs flexibility to address multiple infectious diseases at once. Many of the populations at increased risk for viral hepatitis are also at increased risk for HIV, STDs, and COVID-19.
The impact of COVID-19 on viral hepatitis funding is complex. State and local budgets have taken a hit in the last year, and we are concerned that there may be budget cuts that could set back viral hepatitis programs as a result. Many of those programs had to reduce their activities in 2020 because of COVID-19, and we expect to see an increase in unmet need in 2021. Congress did not allocate any hepatitis-specific funding as part of the COVID-19 stimulus packages in 2020, but we will be advocating for that this year. That said, COVID-19 has also really put a spotlight on the value of a strong public health system, and what happens when that system is neglected. We hope that will spur some members of Congress to champion increasing funding to fight infectious diseases, including viral hepatitis.

TO CONTINUE READING: https://hepvu.org/hepvu-qa-frank-hood-on-the-importance-of-funding-viral-hepatitis-elimination/

A report from Germany provides more evidence that SARS-CoV-2 can invade the liver and cause damage.
"Our study demonstrates once again that COVID-19 is a systemic disease and that SARS-CoV-2 damages the liver and results in vascular injury," Dr. Jan Schulte am Esch of the University Hospital of Bielefeld told Reuters Health by email.
He and his colleagues analyzed liver tissue obtained at autopsy from 60 patients who died of COVID-19 pneumonia in Hamburg between March and June, as well as a control of 13 patients who died of pneumonia but did not have SARS-CoV-2 infection.
Only five patients with COVID-19 and one control had a history of liver disease, the team reports in Clinical Gastroenterology and Hepatology.

"We show in this paper the essential elements of the liver pathology that result in the abnormal hepatic function, seen in severe forms of COVID-19. The changes manifest as thromboses of hepatic micro-vessels and sinusoids with aberrant hepatic regeneration responses, as has already been observed for other forms of viral hepatitis," Dr. Shulte am Esch told Reuters Health.

TO CONTINUE READING: https://www.mdlinx.com/news/more-evidence-that-sars-cov-2-damages-the-liver/6cbEeeJHlppaFTCg0Xx7rp?show_order=2&utm_campaign=All+SP+2%2F6%2F2021+M