In honor of World Hepatitis Day, which is observed on July 28 every year and is one of only four disease-specific days recognized by the World Health Organization (the others being tuberculosis, malaria, and HIV), Project Inform participated in two events in Washington, DC…. (this article is forwarded by Alan McCord of Project Inform)
The first event on July 29 was a viral hepatitis policy strategy meeting hosted by the National Viral Hepatitis Roundtable and the National Alliance of State & Territorial AIDS Directors. At this meeting, over 70 viral hepatitis stakeholders and government officials met to discuss how to realize the goals of the national Viral Hepatitis Action Plan; how to navigate Medicaid coverage of hepatitis B and C testing, care, and treatment; the opportunities provided by the Affordable Care Act to address viral hepatitis; and action planning for the next six months. Of all the issues discussed the one that elicited the most discussion and debate related to the rationing of hepatitis C treatment in state Medicaid programs.
Some attendees expressed frustration at the high cost of new hepatitis C medications and the concomitant rationing of treatment by state Medicaid programs, with many programs only authorizing treatment for people with advanced liver disease. Others described cost-effectiveness studies that demonstrate that treating everyone living with hepatitis C makes the most long-term fiscal sense and is best for people living with the virus. Critically, what came out of the conversation is the need to assess accurately how many people currently diagnosed with hepatitis C in each state have Medicaid coverage. The costs of hepatitis C treatment will be incurred over a period of decades, not immediately, and, during this time, new treatments for hepatitis C will come to market.
At present, the Centers for Disease Control and Prevention (CDC) estimate that 50-75% of Americans living with hepatitis C do not know they are infected. It will take many years of large-scale testing efforts to identify everyone living with the virus and ensure they are effectively linked to medical providers for assessment, ongoing care, and treatment, as appropriate.
The history of addressing HIV, a similar chronic infectious disease, provides a useful analogy. Even with the significant investment in HIV testing, care, and treatment over the last 30 years, only 33% of Americans living with HIV are prescribed antiretroviral therapy and only 25% are virally suppressed. Given this history, Dr. John Ward, the Director of the CDC’s Division of Viral Hepatitis, stated that it will take at least 15 years to successfully test and treat everyone living with hepatitis C.
Attendees called for payers (e.g., state Medicaid programs), the pharmaceutical industry, and other stakeholders to sit down and talk to one another in order to develop compromises and solutions. Many attendees expressed the need for a 10-20 year roadmap to ensure that everyone living with hepatitis C has the opportunity to know their status and be cured. Dr. Jonathan Mermin, Director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention at the CDC, noted that, “Hepatitis C is the most important public health opportunity in the next decade”. Dr. Ward noted that “We should be on an emergency footing regarding hepatitis C incidence and prevalence … We are in a crisis and we need relief” and that even small increases in support for testing, treatment, and surveillance would make “a big difference” toward eliminating hepatitis C in the United States.
The second event, on July 30 was the White House Observance of World Hepatitis Day, co-hosted by the Office of National AIDS Policy and the Office of National Drug Control Policy. At the event, Dr. Howard Koh, Assistant Secretary for Health, who recently left government service to return to teaching at Harvard University, was honored for his service and commitment to viral hepatitis. Dr. Koh provided a “top 10 list” of viral hepatitis successes during the last few years:
- The release of the second Department of Health and Human Services Viral Hepatitis Action Plan.
- The recognition of Hepatitis Testing Day, on May 19, in the United States.
- New screening recommendations from the CDC and the United States Preventive Services Task Force for hepatitis B and hepatitis C.
- New targeted outreach education materials on hepatitis B and hepatitis C.
- Greater attention the hepatitis C among people who inject drugs.
- Work to oppose discrimination against people with hepatitis.
- Work to eliminate perinatal transmission of hepatitis B.
- Exciting new hepatitis C medications that cure most people and have reduced side effects and greater efficacy compared to prior regimens.
- Health reform and the full implementation of the Affordable Care Act.
- Celebrating World Hepatitis Day in the White House for the last several years.
Ambassador Deborah Birx, the United States Global AIDS Coordinator, provided an overview of the opportunities the President’s Emergency Plan for AIDS Relief (PEFAR) has to integrate viral hepatitis prevention, testing, and care into its portfolio. Given the similar routes of transmission that HIV and viral hepatitis share, as well as the high percentage of people with HIV who are co-infected with hepatitis B and/or hepatitis C, PEPFAR’s interest in and involvement with viral hepatitis prevention, care, and treatment is critical to international efforts to combat hepatitis B and hepatitis C.
Dr. Paul Farmer, well known for his international health work and his organization, Partners in Health, described the work his organization has done to ensure state of the art treatments are provided equitably in developed and developing areas of the world. He noted the success of providing antiretroviral therapy to people living with HIV and the model this provides for ensuring access to hepatitis C treatments throughout the world, particularly in places with high prevalence like the prisons in Siberia, in which 30% of prisoners are living with hepatitis C.
Project Inform congratulates all of its partners in the effort to address viral hepatitis, and particularly those who were honored for their leadership at the White House event:
- Sanjeev Arora, MD, Director, Project ECHO, University of New Mexico
- Joan Block, RN, BSN, Co-Founder and Executive Director, Hepatitis B Foundation
- Adrian DiBisceglie, MD, FACP, President, American Association for the Study of Liver Diseases
- Charles Gore, President of the Executive Board, World Hepatitis Alliance
- Holly Hagan, PhD, MPH, RN, Professor, New York University College of Nursing
- Charles Howell, MD, AGAF, Co-Chair, National Medical Association Hepatitis C Consensus Panel
- Jules Levin, MS, Executive Director, National AIDS Treatment Advocacy Project
- Barbara Murray, MD, FIDSA, President, Infectious Disease Society of America
- Michael Ninburg, MPA, Executive Director, Hepatitis Education Project
- Daniel O’Connell, MA, MLS, Director, New York State Department of Health, AIDS Institute
- Daniel Raymond, Policy Director, Harm Reduction Coalition
- Julie Scofield, Executive Director, National Alliance of State & Territorial AIDS Directors
- Samuel So, MD, Director, Asian Liver Center, Stanford University School of Medicine