Ronald O. Valdiserri, Alexander Billioux, Boatemaa Ntiri-Reid, Lauren Canary
June 26, 2020 HEALTH AFFAIRS BLOG      10.1377/hblog20200624.8487510.1377/hblog20200624.84875

As our nation continues to confront the burgeoning pandemic of COVID-19, much has been written about the importance of building and sustaining a strong public health infrastructure to contain the epidemic, minimize its impact, and prepare for future waves of SARS-CoV-2 and other deadly pathogens. For those not working on the front lines, perhaps less obvious has been the pandemic’s effect on other health department programs and services. In the setting of already understaffed and underfunded state and local health departments, the deployment of personnel from their regular duties to work on COVID-19 response has resulted in other key services being reduced or suspended.
Impact Of COVID-19 Response On Other Necessary Public Health ServicesIn a a recent survey of health department sexually transmitted disease (STD) programs, more than half reported negative impacts of the COVID-19 response on the provision of recommended screening, diagnostic, and treatment services. Decreases in the availability of syringe service programs and limitations in access to pre-exposure prophylaxis (PrEP) for HIV have also been reported as a consequence of shifting resources and changing priorities in response to COVID-19. Not surprisingly, viral hepatitis prevention and control programs have also experienced this strain.
In May 2020, the National Alliance of State and Territorial AIDS Directors (NASTAD) conducted a request for information (RFI), asking the viral hepatitis and HIV prevention and care staff of health departments to provide specific details about the impact of the COVID 19 pandemic on public health capacity. The organization found that over 80% of hepatitis program, 75% of HIV prevention program, and 57% of Ryan White HIV/AIDS program staff at health departments reported being detailed to the COVID 19 response. In light of current circumstances, over 90% of the hepatitis programs responding to the RFI indicated that they anticipate reductions in viral hepatitis outreach, education, testing, and linkage to care services.
Effect On Viral Hepatitis Elimination EffortsWhile no public health leader questions the need to respond to SARS-CoV-2 with deliberate speed and appropriate action, the COVID-19 pandemic has emerged at a particularly critical time in America’s effort to eliminate hepatitis C in the United States. Consider the situation in Louisiana. In June 2019, the state announced the creation of an innovative payment model for hepatitis C treatment that would enable it to provide curative therapy for two vulnerable populations disproportionately affected by hepatitis C: persons on Medicaid and those receiving care through the state corrections system. Prior to the program’s launch, approximately 61 persons per month were started on curative treatment for hepatitis C virus (HCV) in state Medicaid and Department of Corrections programs. After a successful implementation, this figure increased dramatically to some 478 persons per month being treated.  However, due to disruptions brought on by the COVID-19 pandemic, the number of new treatment starts dropped to 155 persons in Spring 2020 (mid-March to mid-April). And given constraints in state budgets anticipated in the face of COVID-19 response, other jurisdictions may be slowed or even halted in their efforts to launch viral hepatitis elimination programs.
TO CONTINUE READING: https://www.healthaffairs.org/do/10.1377/hblog20200624.84875/full/

Maggie L. Shaw
Newsroom – Published on: June 18, 2020 AJMC

Despite the CDC’s recommendation, which has been in effect since 1998, study results show that just half of HIV-positive individuals choose to get tested for hepatitis C virus (HCV) in the 12 months following the receipt of their diagnosis.

Just half of individuals with HIV were ever tested for hepatitis C virus (HCV) in the year after receiving their HIV diagnosis, despite being at increased risk for the liver disease, report recent study results that appeared in Open Forum Infectious Diseases. Living in a rural area, too, meant this patient group was the least likely to get tested.

“Because HIV infection can accelerate the natural history of HCV infection leading to increased risk for cirrhosis, liver failure, and hepatitis C–related mortality, all individuals living with HIV should be tested for hepatitis C and linked to care where appropriate,” the study authors noted.

TO CONTINUE READING: ​https://www.ajmc.com/newsroom/having-a-high-risk-of-hcv-does-not-always-lead-to-testing-among-those-with-hiv

Contact: Marissa Tonelli
202.507.4731/ Marissa@HealthHCV.org
May 29, 2020

The Third Annual HealthHCV State of HCV Care National SurveyTM Identifies Workforce Dynamics Impacting HCV Treatment Outcomes

Dynamics Impacting HCV Treatment Outcomes
Washington, DC – Over one-third of current HCV treatment providers are reaching retirement age at the same time they are experiencing HCV caseload increases and planning to scale up treatment, according to the Third Annual HealthHCV State of HCV Care National SurveyTM report. The growing gap of HCV treaters is concerning as survey findings indicate a lack of onsite trained providers across practice settings as well as in key service areas and over half of HCV providers have been practicing for fewer than five years. In community-based settings across the country, primary care providers are at the forefront of the effort to expand HCV treatment access. HCV patients are three-times more likely to be treated by a primary care provider than a specialist, reflecting a key evolution in the HCV care and treatment landscape

As National Hepatitis Awareness Month continues through May, HealthHCV released a comprehensive report of the Third Annual HealthHCV State of HCV Care National SurveyTM findings, which includes first-of-its-kind data on the state HCV care in HIV and primary care settings. The report highlights specific education, training, and financial resources that providers need in order to scale-up HCV services, remain responsive to national guidelines and recommendations, and meet the needs of a growing and diversifying HCV patient population. HealthHCV also launched its HCV Services and COVID-19 Provider Survey during Hepatitis Awareness Month, which will be fielded through June 15, 2020.
Key findings from the 407 providers surveyed in the HealthHCV State of HCV Care National SurveyTM demonstrate notable gaps in the HCV prevention and treatment workforce, including:
HCV Screening Practices

• Only one quarter (27%) of providers are implementing universal HCV screening in accordance with the newest Centers for Disease Control and Prevention (CDC) and U.S. Preventive Services Taskforce (USPSTF) guidelines; the majority (73%) screen based on identified risk factors. 
• Nearly half of providers (43%) requested education/training on the current HCV screening guidelines.
• One third (34%) of providers refer HCV patients offsite for RNA confirmatory testing.
• A majority of providers (44%) report their patients are likely to be lost during linkage to care rather than during other points along the HCV care continuum.

HCV Treatment Practices

• Patients being treated onsite (versus referrals) are three-times more likely to be treated by a primary care provider than a specialist.
• About one quarter (24%) of providers report seeing re-infection among patients; primarily among people who inject drugs (PWID).
• The most significant provider-reported barriers to providing HCV screening, care and treatment services are: limited infrastructure for providing services, lack of trained providers onsite or in their service area, administrative costs, provider stigma, and treatment utilization policies impacting coverage by insurance.
• Over one-third (40%) reported being unable to treat a patient’s infection due to payer restrictions.

HCV Workforce

• Over one third of HCV providers (34%) are reaching retirement age at the same time that nearly half of providers (43%) are experiencing HCV caseload increases.
• Over half of HCV providers (51%) have been practicing for fewer than five years. 
• Most providers (64%) are partnering with community-based organizations that specialize in risk reduction and harm reduction services for PWID (e.g. needle/syringe exchange, methadone clinics) in response to growing patient population with co-occurring substance use disorder or opioid use disorder.

Education & Training Needs

• Providers requested additional education and training on addressing re-infection among HCV patients, monitoring HCV patients not on treatment, appropriate treatment for HCV/HIV co-infected patients, determining when to initiate treatment for HCV, and discussing sexual health, liver health, and substance use with HCV patients.

“Since we have the ability to cure HCV through simplified, quality treatment, it is imperative that limited workforce capacity and insurance coverage are not barriers to HCV testing and treatment,” said HealthHCV Director Marissa Tonelli. “HealthHCV is addressing the workforce training and development needs in primary care settings to ensure more people with HCV have access to screening and curative therapy.”
The HealthHCV State of HCV Care National Survey™ is fielded online annually via SurveyMonkey™. It is distributed through HealthHCV and its partner, Medscape Education, to hundreds of providers in all 50 states, the District of Columbia, Puerto Rico and major U.S. territories.

The Third Annual HealthHCV State of HCV Care National Survey™ report documents the key survey findings and their implications on the HCV provider workforce. View the report at www.HealthHCV.org and access existing HCV resources are available for consumers, providers and advocates on HealthHCV’s online resource center.
For More Information:

​To learn more about the survey, report, or HealthHCV education and training opportunities, please contact:
Marissa Tonelli
Director of HealthHCV
Office:  202.507.4731 
Email: marissa@HealthHCV.org