Keith Alcorn
Published:21 May 2021 INFOHEP

Global targets for reducing deaths from viral hepatitis will not be met without massively accelerating universal access to testing and treatment, the World Health Organization said yesterday in a review of progress towards elimination of hepatitis B and C.The Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021 provides a snapshot of recent statistics on viral hepatitis testing and treatment, as well as recommendations for actions to accelerate progress towards elimination of viral hepatitis.
Around 1.4 million people died from viral hepatitis in 2016, 1.75 million people were newly infected with hepatitis C in 2015 and 1.1 million people were newly infected with hepatitis B in 2017, the most recent years for which the World Health Organization has collated data.
The report reveals that rates of viral hepatitis diagnosis remain low in all regions of the world. Less than one percent of people with hepatitis B in Africa and 2.3% of people with hepatitis B in the Western Pacific region have been diagnosed. Although hepatitis C diagnosis rates are higher in some regions – 36% in the Americas and 21% in the Western Pacific – WHO estimated that only 19% of people with hepatitis C knew their hepatitis C status at the end of 2017.
WHO estimates that $6 billion a year needs to be spent on viral hepatitis testing to achieve the elimination targets by 2030. Innovations in point-of-care testing are also needed to improve access to testing and to simplify linkage to care.
Five million people had been treated for hepatitis C using direct-acting antivirals by the end of 2017. WHO estimates that 9.4 million people are receiving treatment for chronic hepatitis C virus infection, a more than nine fold increase since 2015. 
Lack of finance for viral hepatitis testing and treatment remains a major challenge for many countries but WHO points to successes in the development of national strategies for hepatitis elimination in Asia and the Eastern Mediterranean region, as well as the inclusion of hepatitis B treatment in China’s national insurance scheme.

​TO CONTINUE READING: http://infohep.org/WHO-says-2030-hepatitis-elimination-targets-will-not-be-met-without-massive-scale-up-of-testing-and-treatment/page/3549672/

MAY 18, 2021 • PRESIDENTIAL ACTIONS

​Our efforts to combat the COVID-19 pandemic over the past year have reinforced many public health lessons, including the importance of communication, community engagement, and a comprehensive testing strategy to reduce the spread of infection.  These same lessons hold true for another epidemic affecting our Nation:  the silent epidemic of viral hepatitis.  Viral hepatitis is a serious, preventable public health threat that puts people who are infected at increased risk for serious disease and death.  When left undiagnosed and untreated, hepatitis B and hepatitis C can cause liver cirrhosis, liver cancer, and even early death.  Hepatitis D, which occurs only among individuals infected with hepatitis B, can also cause serious liver disease.  On this National Hepatitis Testing Day, I call on all Americans who are at risk for hepatitis to get tested, and for all health care providers to educate their patients about viral hepatitis.
Our Nation has set a goal to eliminate viral hepatitis by 2030.  Thanks to Federal investment in medical research, we have the technology and tools to provide safe and effective hepatitis vaccines and therapeutics that can reduce mortality and even lead to a cure.  Despite this progress, an estimated 2.4 million Americans are living with hepatitis C, and more than 860,000 are living with hepatitis B — many of whom unknowingly suffer its effects.  Approximately 200,000 Americans are infected with hepatitis D every year.  Infection with hepatitis D in an individual already infected with hepatitis B — known as superinfection — leads to a more rapid progression towards liver cancer.  We must increase prevention, testing, and awareness to provide people the life-saving treatment they need.  Because of the Affordable Care Act, most health insurance plans must cover hepatitis B and hepatitis C testing with no cost-sharing.
The Centers for Disease Control and Prevention recommends screening and testing for hepatitis B, hepatitis C, and hepatitis D based on risk, health status, and pregnancy.  It is important we implement these recommendations to ensure proper treatment and help stop the spread of hepatitis.  For more information on the recommendations, visit cdc.gov/hepatitis.

My Administration is committed to addressing the health disparities and health inequities, which, as with so many health metrics, are also seen with viral hepatitis.  Viral hepatitis disproportionately impacts Black and brown Americans, Indigenous persons, Asian Americans, Native Hawaiians, and Pacific Islanders.  The interplay of factors such as poverty, inadequate housing and transportation, food insecurity, access to care, access to addiction treatment and mental health care, medical mistrust, language and cultural barriers, stigma, and discrimination must be addressed if we are to eliminate these health disparities and advance health equity.  The recently released Viral Hepatitis National Strategic Plan:  A Roadmap to Elimination is focused on making sure more people living with viral hepatitis are tested and aware of their status and providing a roadmap for quality care and treatment.  To read more about the plan, visit hhs.gov/hepatitis. 
The viral hepatitis epidemic is also linked with other public health threats, including HIV, sexually transmitted infections, and opioid use.  Our response to the public health challenges of viral hepatitis, HIV, sexually transmitted infections, and substance use disorders will require a focus on the people and places where these risk factors intersect, and doing more to test people for viral hepatitis and other infections.  We also need to scale-up vaccinations, testing, and care in settings where people at risk receive other services.  Implementing point-of-care testing in outreach settings, utilizing clinical decision support tools, and increasing provider awareness and training for implementing testing recommendations will help improve diagnoses and awareness.  The ability to reduce viral hepatitis infections will depend on integrated strategies and a comprehensive approach to address our ongoing challenges.
Viral hepatitis exacts a significant toll on our Nation’s health, and the stigma and discrimination associated with the disease further impair the quality of life among those affected.  Today, we reaffirm our commitment to ensuring everyone knows their viral hepatitis status, has access to high quality care and treatment, and lives free from stigma and discrimination.

NOW, THEREFORE, I, JOSEPH R. BIDEN JR., President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim May 19, 2021, as National Hepatitis Testing Day.  I encourage all Americans to join in activities that will increase awareness about viral hepatitis and increase viral hepatitis testing. 
IN WITNESS WHEREOF, I have hereunto set my hand this eighteenth day of May, in the year of our Lord two thousand twenty-one, and of the Independence of the United States of America the two hundred and forty-fifth.

JOSEPH R. BIDEN JR.

​https://www.whitehouse.gov/briefing-room/presidential-actions/2021/05/18/a-proclamation-on-national-hepatitis-testing-day-2021/

HHS uses authority under Title IX of Civil Rights Act, cites Supreme Court ruling last year prohibiting discrimination against LGBT workers

By Tarini Parti
May 10, 2021 12:35 pm ET, THE WALL STREET JOURNAL

The Biden administration said it would enforce legal protections against discrimination for gay and transgender patients seeking healthcare under the Affordable Care Act, reversing a Trump-era policy that sought to more narrowly define the scope of sex discrimination under the health law.
The Department of Health and Human Services said Monday that the administration was using its authority under Title IX of the Civil Rights Act to enforce the ACA’s prohibition based on sex discrimination. HHS Secretary Xavier Becerra said the department’s decision was based on a Supreme Court ruling last year that allows the agency to interpret the antidiscrimination section of the ACA, which bans bias “on the basis of race, color, national origin, sex, age or disability,” in a more expansive way.
The Supreme Court ruling in Bostock v. Clayton County said a bedrock federal civil-rights law prohibited employers from discriminating against workers on the basis of their sexual orientation or gender identity. The 6-3 opinion, by Justice Neil Gorsuch, rejected administration arguments that federal civil rights law provides no protection to LGBT employees.
TO CONTINUE READING: https://www.wsj.com/articles/biden-administration-reverses-trump-era-rollback-of-gay-transgender-protections-in-health-care-11620664532?mod=hp_lead_pos12&fbclid=IwAR2dZ9MbYrRCY588pNwtrCaQjXGbZR7MqXTSsaemDf7EUKv4D-l1b68n-K0r
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May 7, 2021
Kenny Walter

The CDC currently recommends every pregnant woman screened for hepatitis C virus.

New research shows only screening for hepatitis C virus (HCV) by risk in pregnant women results in a large percentage of missed diagnoses.
A team, led by Elisa T. Bushman, Center for Women's Reproductive Health, University of Alabama at Birmingham, examined whether universal screening is linked to increased HCV diagnoses and postpartum linkage to HCV care compared to risk-based screening.
Current recommendations from the US Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF) call for universal hepatitis c virus screening in pregnant women.In addition, the Society for Maternal-Fetal Medicine (SMFM) and American College of Obstetricians and Gynecologists (ACOG) recommend risk-based screening for HCV in pregnancy.
In the retrospective cohort study, the researchers examined pregnant women who were screening for hepatitis C at a single tertiary-care center. The patients were split into 2 cohorts—women managed with risk-based screenings between January 2014 and October 2016 and women universally screened between November 2016 and December 2018.
ScreeningsScreening was performed with ELISA antibody testing, which was viremia confirmed with HCV ribonucleic acid (RNA) polymerase chain reaction (PCR) tests.
The researchers sought primary outcomes of the rate of HCV screen positivity and postpartum linkage to care.
Overall, there were 16,489 women included in the study between 2014-2018, 7039 of which were screened for HCV. Of the patients screened, 266 were part of the risk-based cohort and 6773 were part of the universal screening cohort.
Positive RateThere was a 29% (n = 76) positivity rate for HCV antibody screening (HCVAb + ) in the risk-based cohort and 1.3% (n = 90) in the universal cohort.
However, only 69% (n = 62) of HCVAb+ women in the universal cohort met the criteria for risk-based testing and of the remaining 28 women, 21% (n=6) had active viremia (HCV RNA+).
The researchers also found 64% (n = 103) of the HCVAb+ women were HCV RNA+—51 of 266 (19%) in the risk-based and 52 of 6773 (0.8%) in the universal cohort.
In addition, 75% (n = 125) of HCVAb+ womenwere referred postpartum for HCV evaluation and 27% (n = 34) were linked to care and only 9% (n =10) of women with viremia-initiated treatment within 1 year of delivery.
“Universal HCV screening in pregnancy identified an additional 31% of HCVAb+ women compared with risk-based screening,” the authors wrote. “Given low rates of HCV follow-up and treatment regardless of screening modality, further studies are needed to address barriers to postpartum linkage to care.”

​TO CONTINUE READING:https://www.hcplive.com/view/universal-screening-hcv-option-pregnant-women

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