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

PUBLIC NEWS SERVICE

LOUISA, Ky. -- As the coronavirus pandemic continues to strain the state's health care system, providers are concerned about another viral infectious disease spreading under the radar.

The hepatitis C virus damages the liver and can lead to liver cancer and death. It's transmitted through the blood, which is why it's prevalent among people who are intravenous drug users. Kentucky currently leads the nation in the number of hepatitis C infections, and ranks number two in the country for the number of infants exposed to the virus at birth.

Lynn Hill is a nurse practitioner in Lawerence County. She said COVID-19 is scaring patients away from getting treatment, so her hospital has adapted.

"So we adjusted things, we did telehealth; we were able to have the medication shipped to the patient's home," Hill said. "At our hospital, you can have bloodwork done from your car, so the patient doesn't have to go in and be worried about exposure."

Hill added that medications treating hepatitis C are effective and in most cases can rid the body of the virus within a few months. According to the latest data, it's estimated there are at least 42,000 Kentuckians living with hepatitis C.

TO CONTINUE STORY:
​https://www.publicnewsservice.org/2020-05-18/health-issues/providers-worry-hepatitis-c-infections-may-worsen-amid-pandemic/a70213-1

​Alexander Lekhtman 2Days

The adulteration of many drug supplies with the potent synthetic opioid fentanyl poses a serious risk for people who use illicit drugs of all kinds. But those who use substances other than opioids are more likely to be unaware of the risk or how to mitigate it. Public health officials in New York City issued safety information to cocaine users through bars and nightclubs—and a review of their strategy indicates that it was effective.
Many people might be aware of fentanyl’s presence in heroin supplies. Unfortunately, there is much less awareness of how it is also found in stimulants like cocaine or methamphetamine. Since 2016, there has been a faster national increase in fentanyl-and-cocaine-related deaths than in fentanyl-and-heroin deaths.
In New York City, nearly four in 10 deaths related to cocaine also involve fentanyl. People who use only cocaine have not developed tolerance to opioids, and may not know about vital resources like fentanyl testing strips or naloxone. Knowledge, in this case, really can save lives.
In spring 2018, the NYC Department of Health and Mental Hygiene (DOHMH) contacted 47 bars, nightclubs and music venues in downtown Manhattan about participating in a public information campaign. The venues were not known sites of fentanyl-involved overdoses, just places where people regularly consumed alcohol and likely, cocaine. Twenty-three venues agreed to participate.
The health officials gave the nightlife venues posters and drink coasters displaying information about how to avoid fentanyl overdose. “Using cocaine tonight?” the posters read. “Fentanyl, a drug stronger than heroin, is being mixed into cocaine and is causing a spike in overdose deaths. You can’t see, taste, or smell fentanyl.”
The posters also offered simple safety tips: “Use with others. If you overdose, it’s important to have someone else around to help. Have [naloxone] on hand and tell others how to use it. It could save your life.”

TO CONTINUE: https://filtermag-org.cdn.ampproject.org/c/s/filtermag.org/bars-nightclubs-deaths-fentanyl/amp/

​As overdose deaths climb, advocates and activists fear the opioid crisis will run headlong into the Covid-19 crisis.
​By Sophie Pinkham

​In mid-March, as the Covid-19 pandemic was accelerating, Shantae Owens found a man unconscious in a public bathroom in Tompkins Square Park, in New York’s East Village. Owens wasn’t surprised at his discovery. He was on street outreach distributing naloxone, which helps reverse opioid overdoses, as well as syringes, condoms, and other health supplies. He administered naloxone and called 911. The ambulance took longer to arrive than usual.
Owens is an outreach worker with the Lower East Side Harm Reduction Center, which has temporarily stopped doing outreach due to Covid-19-related safety concerns. But he still covers the parks, public restrooms, and drug houses of the South Bronx, Washington Heights, and Lower Manhattan as a volunteer with VOCAL-NY, a grassroots organization that grew out of the AIDS epidemic and is staying open during the lockdown. Many harm reduction programs are still running as essential services, though others, such as those that operate out of county health departments, like Michigan’s, are now largely closed because of Covid-19. Owens is concerned about what the lockdown will mean for drug users—in particular, for people who use opioids and are at high risk of fatal overdose. “We fear that overdose is going to rise,” Owens told me, “because there’s not enough services. We’ve already lost so many people to the overdose crisis.”
Around the country, organizations that work to reduce drug-related harms such as overdose, HIV, and hepatitis C are now facing yet another devastating virus. And for active drug users, people in drug treatment, and people without stable housing, business closures and physical distancing mandates are causing a cascade of economic and practical difficulties that compound health dangers. “I worry for my community,” said Kelly Culbert, who works at NYHRE, an East Harlem harm reduction center that has closed temporarily. “They’re scared. They have very little access to equipment [for safer drug use]. And everything has become more problematic—from the ways people were making their money to locating a dealer and that person having an adequate supply. It’s all become riskier, less available.”

Among the harms that advocates like Culbert fear most are a spike in overdoses, increased syringe sharing, and a choice between self-isolation and excruciating drug withdrawal. There are already reports from across the country of increased overdose rates.
Project SAFE works with women and queer people who use drugs in Philadelphia’s Kensington neighborhood, delivering harm reduction supplies and offering a place to take a shower or a nap. Many program participants are precariously housed and stay up all night to avoid being assaulted; they need a place to help them escape the cycle of exhaustion.

TO CONTINUE READING:​https://www.thenation.com/article/society/harm-reduction-coronavirus/

Matthew J. Akiyama, M.D., Anne C. Spaulding, M.D., and Josiah D. Rich, M.D.T
​The New England Journal of Medicine
​

Matthew Akiyama is the Medical Advisor to HCMSG

​Because of policies of mass incarceration over the past four decades, the United States has incarcerated more people than any other country on Earth. As of the end of 2016, there were nearly 2.2 million people in U.S. prisons and jails.1 People entering jails are among the most vulnerable in our society, and during incarceration, that vulnerability is exacerbated by restricted movement, confined spaces, and limited medical care. People caught up in the U.S. justice system have already been affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and improved preparation is essential to minimizing the impact of this pandemic on incarcerated persons, correctional staff, and surrounding communities.
Populations involved with the criminal justice system have an increased prevalence of infectious diseases such as HIV and hepatitis C virus (HCV) infections and tuberculosis. Disparities in social determinants of health affecting groups that are disproportionately likely to be incarcerated — racial minorities, persons who are unstably housed, persons with substance use disorders or mental illness — lead to greater concentrations of these illnesses in incarcerated populations. Yet implementation of interventions to address these conditions is often challenging in correctional settings owing to resource limitations and policy constraints. Therefore, comprehensive responses that straddle correctional facilities and the community often need to be devised.

 For example, HCV, which is the most prevalent infectious disease in incarcerated populations, is most commonly spread through injection drug use. Transmission can be reduced using measures known to reduce high-risk behaviors, such as opioid agonist therapy and syringe exchange. Although much of the country has yet to implement these strategies in correctional settings, managing transitions in care to and from the community and providing such services to people after incarceration has a large impact. Similarly, we have learned that controlling infections such as HIV and HCV in correctional settings can have positive effects both in these settings and on surrounding communities, as a form of treatment as prevention.
TO CONTINUE READING: https://www.nejm.org/doi/full/10.1056/NEJMp2005687

By Jacqueline Howard, CNN​Updated 5:13 AM ET, Fri April 10, 2020

​(CNN)The annual rate of newly reported hepatitis C infections in the United States has increased threefold, according to the US Centers for Disease Control and Prevention.

A new CDC report finds that the annual rate rose from a rate of 0.3 cases per 100,000 people in 2009 to a rate of 1.2 per 100,000 people in 2018. That report also makes new recommendations for all adults to get screened for hepatitis C at least once in their lifetimes.
The new Vital Signs report included data on confirmed acute hepatitis C cases between 2009 and 2018 from the CDC's National Notifiable Diseases Surveillance System. Hepatitis C is the most commonly reported bloodborne infection in the United States.
The report, published in the CDC's Morbidity and Mortality Weekly Report on Thursday, finds that the highest rate of new hepatitis C cases in 2018 was among younger adults ages 20 to 39.


Among adults ages 20 to 29, rates increased about 300% from 0.7 per 100,000 in 2009 to 3.1 per 100,000 in 2018. Among adults ages 30 to 39, rates increased about 400%, from 0.5 per 100,000 in 2009 to 2.6 per 100,000 in 2018, according to the report.
According to the CDC, hepatitis C previously was seen as a concern primarily for baby boomers and people with risk factors, such as injection drug use, but the new data finds that in 2018:

• Millennials, or those born during 1981 to 1996, accounted for 36.5% of newly reported chronic hepatitis C infections.
• Baby boomers accounted for 36.3% of newly reported chronic infections.
• Generation X, born during 1966 to 1980, accounted for 23.1% of newly reported chronic infections.

 TO CONTINUE READING:https://www.cnn.com/2020/04/10/health/hepatitis-c-infection-rate-rises/index.html

​Recommendations and Reports / April 10, 2020 / 69(2);1–17
Sarah Schillie, MD1; Carolyn Wester, MD1; Melissa Osborne, PhD1; Laura Wesolowski, PhD1; A. Blythe Ryerson, PhD1 

Recommendations
​
The following recommendations for hepatitis C screening augment those issued by CDC in 2012 (5). The recommendations issued by CDC in 1998 remain in effect (6). CDC recommends (Box 1):

• Universal hepatitis C screening (new recommendations):
  • Hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%
  • Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%
• One-time hepatitis C testing regardless of age or setting prevalence among persons with recognized conditions or exposures (existing recommendations):
  • Persons with HIV
  • Persons who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis and persons with persistently abnormal ALT levels
  • Prior recipients of transfusions or organ transplants, including persons who received clotting factor concentrates produced before 1987, persons who received a transfusion of blood or blood components before July 1992, persons who received an organ transplant before July 1992, and persons who were notified that they received blood from a donor who later tested positive for HCV infection
  • Health care, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV-positive blood
  • Children born to mothers with HCV infection
• Routine periodic testing for persons with ongoing risk factors, while risk factors persist:
  • Persons who inject drugs and share needles, syringes, or other drug preparation equipment
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis
• Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risk.  
  
• https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm?s_cid=rr6902a1_w&deliveryName=USCDCNPIN_171-DM25236

​Medscape Medical News:
Pam Harrison, March 23, 2020

Liver cancer rates have been increasing, but a new analysis finds that the increase has occurred primarily in men older than 60 years in developed countries.
The findings come from an analysis of data from the Global Burden of Disease (GBD) Study 2017, published online March 23 in Cancer.

From 1990 to 2017, the number of cancer cases increased nearly threefold in older men and more than twofold in older women (aged 60 years or more). This increase was driven mainly by an increase in liver cancer caused by nonalcoholic steatohepatitis (NASH), also termed fatty liver disease, note the authors.
In contrast, the incidence of liver cancer among men and women who are younger than 30 years and those aged 30 to 59 years declined during this period.

The decreases seen in younger adults were largely ascribed to hepatitis B virus (HBV) vaccination and were consistent in most regions except in developed countries, where liver cancer rates increased irrespective of sex and age.
"Our findings suggest a lack of attention for older people in current liver cancer prevention efforts and highlight the emerging concern of obesity as a risk factor for liver cancer," lead author Xingdong Chen, MD, PhD, Fudan University, China, said in a statement.
"Liver cancer prevention strategies in both developing and developed countries should be tailored and updated," he added.
The authors point out that liver cancer was previously considered to be rare in the Western hemisphere.
"However, we found a significant increase in primary liver cancer incidence —regardless of etiology, sex, or age — in most of these countries over the last few decades," they observe.
The fact that the most pronounced increase in liver cancer was caused by NASH suggests that more attention should be paid to weight management and obesity control as primary prevention strategies in these regions, they suggest.
Study DesignAnnual incidence data were collected from 1990 to 2017 and were categorized by sex, region, country, age group, and etiology.
"Data from a total of 195 countries and territories were available," the investigators note, "and these countries and territories were categorized into 5 regions in terms of sociodemographic index (SDI)," they add.
Data were also retrieved regarding five etiologies of liver cancer: HBV infection, hepatitis C virus (HCV) infection, alcohol use, NASH, and others.
The authors note that age-standardized incidence rates of primary liver cancer caused by those five etiologies increased significantly in Australasia, Western Europe, and high-income regions of North America. The most significant increase was found in liver cancer caused by NASH in the Netherlands (in men) and in Finland (in women).
An increasing trend was observed in most countries for primary liver cancer among people aged 60 years or older, the authors note. They suggest that population expansion, aging, and increasing prevalence of obesity and diabetes might partly explain the marked increase, especially the dramatic increase in the number of cases among older people. Additionally, the "lag effect" of the large HBV infection reservoir in several countries might also contribute to the increase, the authors state. They explain that people infected with HBV early in life may experience progression to liver cancer as they age.
Primary PreventionPrevention of HBV infection — the primary cause of liver cancer — has been possible since the introduction of the HBV vaccine in 1982.
"By the end of 2017, 187 countries had introduced the HBV vaccine into their national immunization schedules, with global coverage with 3 doses of the hepatitis B vaccine...estimated at 84%," the authors point out.
This has "dramatically" reduced both the prevalence of HBV infection and the incidence of liver cancer caused by it among younger people in high-risk countries, they comment.
The investigators also observed a significant decrease in the incidence of liver cancer caused by HBV infection in people aged 30 to 59 years, although the decline was smaller than it was for those younger than 30.
Moreover, HCV infection has emerged as a concerning cause of liver cancer among those who used to be at low risk for HCV infection.
Although there is optimism that global control of HCV infection can be achieved through direct-acting antiviral agents, "the high cost, drug resistance, and reinfection rates are still major obstacles to fulfilling this ambitious goal," Chen and colleagues point out.
TO CONTINUE READING: https://www.medscape.com/viewarticle/927374

On the morning of Friday, March 13th, Mary Beth Appel and Johanna Berrigan, two health-care workers who run a free clinic in North Philadelphia, were preparing for the morning rush. Their clients are experiencing homelessness, and sleep in abandoned buildings, shelters, or on the street nearby. “We see the same things that an urgent-care clinic does,” Appel, a sixty-year-old nurse practitioner, told me. The most common ailments included colds, wounds, chronic illnesses, and some frostbite. Today, though, they were bracing for the arrival of covid-19. “I fully expect we’ll both get it. Don’t you?” Appel asked Berrigan, a sixty-four-year-old physician assistant. The women were seated on the first floor of the clinic, a converted row house, discussing how to contain infection among their clients. “The protocol now, if you feel sick, is go home and isolate,” Berrigan said. “Where are our people going to go? We’re going to isolate them under a tree in the park?”
The health-care clinic is one of two or three in the country that are part of the Catholic Worker Movement, a loose-knit social-justice organization started by Dorothy Day and Peter Maurin, in 1933. Appel and Berrigan had been running the clinic for almost twenty-nine years, and had treated patients through the aids crisis, the crack epidemic, and, more recently, widespread addiction to opioids. They were well-acquainted with the difficulties of meeting human needs during a crisis: Berrigan travelled to Iraq, in the nineties and early two-thousands, to document the impact of economic sanctions on its people, and helped provide care in Haiti in the aftermath of the earthquake that devastated  the island in 2010. Still, they had never seen anything like the coronavirus. When I arrived, Appel had just spoken to a fellow Catholic Worker, in New York, to ask for advice on how to pray for the protection of their patients. “I was looking for the patron saint of spit,” she told me, only half joking. “There is one for bed bugs.”
TO CONTINUE READING:https://www.newyorker.com/news/dispatch/how-do-you-shelter-in-place-when-you-dont-have-a-home

​Follow The New Yorker’s latest coverage of covid-19.View all stories

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FOSTER CITY, Calif.--(BUSINESS WIRE)-- Gilead Sciences, Inc. (NASDAQ: GILD) announced today that the U.S. Food and Drug Administration (FDA) has approved a supplemental New Drug Application (sNDA) for Epclusa® (sofosbuvir 400mg/velpatasvir 100mg; sofosbuvir 200mg/velpatasvir 50 mg) for the treatment of people with chronic hepatitis C infection (HCV) as young as 6 years of age or weighing at least 17 kg, regardless of HCV genotype or liver disease severity. The recommended dosage of Epclusa in children ages 6 years and older is based on weight and liver function. Epclusa is the first pan-genotypic, protease inhibitor-free regimen approved in the United States for adults and children.
In the United States, there are approximately 23,000-46,000 children living with HCV. Children born to mothers with HCV are a growing concern, increasing in prevalence by 60 percent from 2011 to 2014. Additionally, engagement in high‐risk practices, such as intravenous drug use, is an increasingly common route of HCV transmission in adolescents and young adults.
“While the treatment of HCV has been transformed in recent years, physicians caring for some children have still needed to take several factors into consideration, including genotype and liver disease severity, when selecting the appropriate treatment plan,” said Kathleen B Schwarz, M.D., Professor of Pediatrics, Johns Hopkins University School of Medicine. “The expanded approval of Epclusa can help eligible children living with HCV combat this life-threatening and debilitating disease.”
TO CONTINUE READING:  https://www.gilead.com/news-and-press/press-room/press-releases/2020/3/us-food-and-drug-administration-approves-epclusa-sofosbuvirvelpatasvir-for-children-ages-6-and-older-or-weighing-at-least-17-kg-with-chronic-hep