A National Strategy for the Elimination of Hepatitis B and C Phase Two Report (2017) / Chapter Skim
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5 Service Delivery
5 Service Delivery
Pages 113-146
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From page 113... ...
. Hepatitis C is common among people who inject drugs, for whom hepatitis treatment is often not a high priority and who feel discriminated against in medical settings (Grebely et al., 2015; Mehta et al., 2011; Treloar et al., 2010)
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From page 114... ...
Recommendation 5-1: The National Committee for Quality Assurance should establish measures to monitor compliance with viral hepatitis screening guidelines and hepatitis B vaccine birth dose coverage and include the new measures in the Healthcare Effectiveness Data and Information Set. HEDIS measures compel a certain attention from providers and health plan managers because they are used to evaluate performance (NCQA, 2012)
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From page 115... ...
Fewer than a third of chronic hepatitis B patients in the United States are aware of their condition (Lin et al., 2007) ; about half of those with chronic hepatitis C are (Denniston et al., 2012)
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From page 116... ...
Regardless of what assay is used, an increase in screening would translate into vastly fewer undiagnosed viral hepatitis patients. The Hepatitis B Vaccine Birth Dose NCQA includes various measures of child and adolescent immunization as HEDIS indicators, including full immunization against HBV during the first 2 years of life (NCQA, 2009)
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Hepatitis patients are usually healthy; only about 20 to 25 percent of chronic hepatitis C patients will develop cirrhosis after two or three decades of infection (Hepatitis C Online, 2016)
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Its goal is to provide primary care doctors in rural and underserved areas the skills and support to manage complex chronic conditions, such as hepatitis C (Project ECHO, n.d.-a)
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. Since 1999, the University of Washington's IMPACT3 program has worked with primary care providers to improve outcomes among elderly people with depression and other complex health needs (Unützer et al., 2002b)
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has shown support for, as with its AIDS Education and Training Centers, a feature of the Ryan White program, discussed later in this chapter. In an effort to ensure standard training across the country, IDSA and AASLD might consider developing a joint guideline, with a training curriculum, for primary care providers to use.
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. The primary goal of conferencing with specialists should be training primary care providers to manage most of the patients themselves.
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From page 122... ...
In any case, bringing hepatitis services to challenging populations will be an integral part of hepatitis elimination, and as such it warrants more explicit attention from the federal and state agencies involved, as well as from various local and community organizations. The Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (hereafter, the Ryan White Act)
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The Ryan White Act already reaches viral hepatitis patients who also have HIV, the vast majority of whom have a history of injection drug use (Grebely et al., 2013; Thomas et al., 2011)
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There are also viral hepatitis patient groups who do not overlap with the Ryan White population. Federally qualified health centers (FQHCs)
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. However, in 2016, the CDC redirected the program that supported the viral hepatitis prevention coordinators toward improving testing and linkage at federally qualified health centers and safety-net hospitals and
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. Among women of childbearing age, the prevalence of chronic hepatitis B was 8.9 percent among people born in Asia, compared to 0.14 percent among Asian Americans born in the United States (Smith et al., 2012)
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From page 127... ...
. An ongoing randomized trial is exploring the use of patient navigators and mobile messaging to improve care for Asian Americans with chronic hepatitis B (Chak et al., 2016)
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. Injection drug use is the behavioral health problem most closely associated with hepatitis B and C (CDC, 2016f)
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From page 129... ...
Nevertheless, most prisoners, especially those with hepatitis B, will need help to ensure continued medical care. Underinsured The Commonwealth Fund estimates that 31 million Americans are underinsured, meaning that their out-of-pocket health costs are more than 10 percent of their household income (or 5 percent of household income for people under 200 percent of the federal poverty line)
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Similarly, a 2014 study of New York City jail records found a 20 percent prevalence of HCV antibody, suggesting a similar 14 to 16 percent prevalence of chronic hepatitis C (Akiyama et al., 2016)
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Recommendation 5-4: The criminal justice system should screen, vac cinate, and treat hepatitis B and C in correctional facilities according to national clinical practice guidelines. Having sufficient staff to test prisoners for viral hepatitis and, depending on the result, manage prevention or treatment programs can be a problem for the correctional system.
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From page 132... ...
The same can be done to support primary care providers who manage viral hepatitis patients in correctional facilities. The use of telemedicine is consistent with recommendations from the national commission, and a modest majority of state prisons are already moving toward phone and video health consultations (NCCHC, 1998; Schaenman et al., 2013)
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From page 133... ...
If many inmates are shown to be vulnerable to infection, prison health officers might be able to make a stronger case to their state authorities for support of hepatitis B immunization. Hepatitis C in Correctional Facilities In 2003, the CDC recommended screening all inmates with a history of injection drug use for hepatitis C (Macalino et al., 2005; Weinbaum et al., 2003)
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n.d. Ryan White program.
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:1015-1017. Boston Health Care for the Homeless Program.
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2008. Underestima tion of chronic hepatitis B virus infection in the United States of America.
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2012. Colorado's Ryan White screening, brief intervention, and referral to treat ment collaborative project to address substance use in HIV/AIDS case management and health-care settings.
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2015. Integrated care increases treatment and improves outcomes of patients with chronic hepatitis C virus infection and psychiatric illness or substance abuse.
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2015. Ryan White HIV/AIDS pro gram: Part B manual.
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2009. The natural history of chronic hepatitis B virus infection.
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2014. Expanding primary care capacity to treat hepatitis C virus infection through an evidence-based care model -- Arizona and Utah, 2012-2014.
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2016. Nonmetropolitan federally qualified health centers.
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2014. HIV care providers emphasize the importance of the Ryan White pro gram for access to and quality of care.
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http://www.hepatitis.va.gov/products/patient/treatment-update.asp#S11X (accessed November 3, 2016)
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2009. Community-based treatment for chronic hepatitis C in drug users: High rates of compliance with therapy despite ongoing drug use.
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