Liver Health Connection en La Habana, Cuba

In early April, Liver Health Connection board member Dr. Marcelo Kugelmas organized a delegation of U.S. hepatologists to educate and learn from hepatologists and gastroenterologists in Cuba.  Pictured below are some of the attendees of the Hepatology and Liver Transplant Symposium in Havana, Cuba including doctors from the United States, Cuba and Spain as well as Liver Health Connection’s Executive Director Nancy Steinfurth.


The U.S. hepatologists shared their expertise in liver transplantation, hepatitis C treatment, liver cancer and non-alcoholic fatty liver disease among other topics.  Dr. Zobair Younossi from Inova Fairfax Hospital in Virgina is shown here sharing an overview of hepatitis C treatment in the United States.


The Cuban doctors shared on their highly successful efforts to eradicate hepatitis B in the country.  More than 99% of newborn are vaccinated for hep B and in 2016 the whole Cuban population under 36 years of age was covered by the vaccination program. Part of the success in HBV elimination is a the extensive medical care that women receive during pregnancy – pictured here is an old bank converted into clinic for pregnant women who receive daily monitoring during the final weeks of pregnancy.


As for hepatitis C prevention and treatment, the U.S. delegation was surprised to learn: 1) injection drug use is practically nonexistent in Cuba; and 2) pegelated interferon (which they produce in Cuba) is still the standard treatment for hep C on the island.  Based on these two facts alone, it’s obvious the both countries can benefit from ongoing communication with each other about viral hepatitis.

The trip of course was not all shop talk.  The delegation had the opportunity to see the country such as the Univeridad de Habana pictured here . . .Cuba4

. . . and the Habor de Habana seen here.



How the Affordable Care Act Helps People with Hepatitis B and C


How the Affordable Care Act (ACA) Helps People with Hepatitis B and C

Preventive services
Under the ACA, all new health plans and Medicaid expansion programs must offer free preventive services, including hepatitis B vaccination and hepatitis B and C testing. These services are essential to prevent new infections and link individuals to lifesaving care and treatment. The ACA also created the Prevention and Public Health Fund, which has improved access to the hepatitis B vaccine.
Expanded coverage for communities disproportionately affected by hepatitis C
African Americans have higher rates of hepatitis C than other ethnic groups. Since the ACA’s enactment, the uninsured rate has declined 59% for African Americans. The uninsured rate for veterans, who also have higher rates of hepatitis C, has dropped 42%. Because the ACA permanently authorized funds for the Indian Health Care Improvement Act, more Native Americans have gained coverage. The ACA has also expanded health coverage for an estimated 4.2 million Latino adults and 676,000 Latino children. Expanded coverage for these populations is crucial to eliminating hepatitis C.
Pre-existing conditions
The ACA prohibits private insurers from discriminating against people with pre-existing conditions. Before the ACA, people with pre-existing conditions like hepatitis B or C were often automatically denied coverage. The ACA’s protection of people with pre-existing conditions ensures that people with hepatitis B or C can be tested and treated.

No annual or lifetime limits
The ACA’s elimination of lifetime or annual limits on the amount of insurance available has enabled persons with viral hepatitis to successfully treat and manage their disease, saving lives and helping to stop new infections.

Expanded Medicaid eligibility
The ACA allows states to expand Medicaid to cover people with incomes at or below 138 percent of the federal poverty level, including single adults without children. In states with the Medicaid expansion, viral hepatitis prevention and care are now more accessible to low-income persons.

More affordable coverage
Under the ACA, the federal government provides financial assistance to many low-income people who obtain coverage through their state’s marketplace. Low-income people with hepatitis B or C need this assistance to receive core services.
Equal coverage for substance use disorders
The ACA requires insurers to offer equal coverage for substance use treatment. People who contracted viral hepatitis from opioid overuse can get treatment for their addiction as they would for any other medical condition.

New Community Outreach Coordinator at Liver Health Connection

RicaRodriguezLiver Health Connection would like to welcome Rica Rodriguez as our new Community Outreach Coordinator!

Rica Rodriguez was born in Amarillo Texas and was raised the majority of her life all over the state of Colorado. She has worked for nearly ten years primarily in the case management field working with individuals from all lifestyles whom struggle from health disparities such as HIV/AIDS, mental health disorders, HIV/HCV co-infected, substance abusers and the homeless populations

Rica has a passion for working with underserved populations and she has the ability to relate to many of their situations, barriers and stigma that these individuals encounter on a daily basis.

Rica has a strong belief that one person’s experience can help in the process of assisting others to overcome obstacles and empower themselves. She comes to Liver Health Connection with a wealth of experience in networking, community outreach, testing and relationship building.

Before coming to Liver Health Connection, Rica has been employed with Planned Parenthood of the Rocky Mountains, the Empowerment Program, Aurora Mental Health Center, Rocky Mountain CARES and the Women’s Lighthouse Project.  This experience and her knowledge make Rica a wonderful addition to the Liver Health Connection team.

Legislature Lunch&Learn


On Monday March 6th, Liver Health Connection, member of the Chronic Care Collaborative hosted a lunch&learn to discuss,”How to Prevent Liver Cancer in Four Easy Steps.” Activities included free box lunch for all attendees and free HCV antibody testing.



Robert McGoey and Karen Chappelow set up for the HCV antibody testing.


Nancy Steinfurth, Robert McGoey and Nicole Silva at the Colorado State Capitol.


Executive Director of Liver Health Connection, Nancy Steinfurth.



Nancy speaking about ways to safeguard your health from liver damage to legislative aides.

Colorado VA’s Rural Hepatitis Telemedicine Program

The Veterans Administration (VA) has initiated an ambitious program to provide hepatitis C (HCV) treatment to all veterans with the virus.  The VA is treating all veterans with HCV regardless of fibrosis score or other criteria.

Becky Ashcraft, Nurse Coordinator for the Colorado VA’s Rural Hepatitis Telemedicine Program, recently presented some of the progress that they’ve been making to ensure that Colorado veterans who live in rural areas can receive treatment for hepatitis C.

We’d like to share just a little bit from her presentation highlighting the work that they Program are doing. The Rural Hepatitis Telemedicine Program is working to bring HCV treatment to rural areas of Colorado by using technology to help patients receive specialist care in rural areas.


This slide shows the uptick in patients being treated by the programs during 2016.  Increased VA funding for HCV treatment has led to a substantial increase in the number of veterans being treated.


Patient compliance with the treatment regimen – which usually involves taking a pill once a day for 12 weeks – has been around 95%.  Patients receive medication through the mail and have appointments at one of several clinics throughout the state.


Sustained Virological Response (SVR) means that a there is no detection of HCV in a patient 12 weeks after completing treatment.  SVR is how we know someone has been cured of HCV.  The Rural Hepatitis Telemedicine Program helped 73 patients achieve SVR in 2016.  For only a handful of patients, treatment was unsuccessful.

Screen shot Va presentation4.png

This final slide show why it’s so important that more veterans are being treated.  Veterans have higher rates of HCV than the general population, especially veterans who are baby boomers.  The data above shows reductions in mortality and liver cancer for veterans who have been cured of HCV compared to veterans who still have the virus.  Because Direct-Acting Antiviral (DAAs) treaments for HCV are still so new, the data above is of patients who underwent successful treatment using interferon-based therapy – a treatment that was less effective and had far more complications than new DAAs.  As  more veterans get treated, we can anticipate even greater reductions in the number of liver transplants, rates of liver cancer and overall mortality.

2017 Chronic Disease Legislator Lunch&Learn

 chronoic-care-collaborative-logo                                   LiverHealthConnectionLogoK


You’re invited!

“How to Prevent Liver Cancer in Four Easy Steps”

The 2017 Chronic Disease Legislator Lunch & Learn on Monday, March 6th!

Please join Liver Health Connection, a member of the Chronic Care Collaborative, for a free box lunch on Monday, March 6th at the Colorado State Capitol to discuss ways to safeguard your health from liver cancer.

Liver cancer is on the rise – 72% in a decade. Undiagnosed hepatitis C is the primary reason for this increase in liver cancer. Free HCV antibody testing will be provided with results in 20 minutes to baby boomers (born between 1945 and 1965.)

Activities take place at the Colorado State Capitol in House Committee Rooms 109 and 111.  We will begin at noon until 1:15pm.

We hope to see you there!



Denver State Capital

Viral Hepatitis in Colorado

viral-hep-in-co-2015-surveil-reportThe Colorado Department of Public Health and the Environment (CDPHE) recently released Viral Hepatitis in Colorado: 2015 Surveillance Report, CDPHE’s annual report on the impact of hepatitis A, hepatitis B and hepatitis C on Colorado’s communities.

The report is full of important information and statistics about new cases of viral hepatitis, who’s most impacted and what steps could be taken to eliminate viral hepatitis.  Here are a few key findings:

  • There are an estimated 70,935 Coloradans currently infected with HCV.
  • There are an estimated 16,370 Coloradans currently infected with HBV.
  • Most Colorado children (92.1% in 2015) receive all three doses of HBV vaccine by age 3, ye only 76.4% of newborns received the first dose of vaccine within the first three days of birth as recommended.
  • Mortality due to hepatitis C is increasing in Colorado, particularly among people born between 1945 and 1965.

Eliminating hepatitis B and hepatitis C is feasible if key barriers are addressed.  These include strengthening surveillance, expanding diagnosis, including prison inmates, and improving access to direct-acting antiviral drugs for hepatitis C.

Read the full report (and past reports) at the CDPHE Viral Hepatitis Data Page.

CO prisons allow preventable killer to lurk in the cells

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An important article in today’s Westword brings light to the status of Colorado prisons and their approach to hepatitis C prevention and treatment. This is a MUST read. #hepatitis #hepC #NoHep

Hep C: The Deadliest Killer in Colorado’s Prisons Is a Curable Virus

When Joseph Deaguero went to prison almost three years ago, he had a pretty good idea of what to expect. He had been behind bars before, for a series of assaults and domestic-violence arrests. But this time around, Deaguero, who’s currently 52 years old and serving a twelve-year sentence for second-degree assault, began to wonder if he was going to survive the experience.


In 1996, Deaguero learned that he’d tested positive for hepatitis C, a blood-borne virus that attacks the liver and has infected 17 percent of the American prison population. At the time he was told not to worry about it; the virus can lie dormant in the system for decades without manifesting any symptoms, and about one in six of those infected will “clear” the virus on their own. In other cases, though, the virus leads to chronic liver disease, and a sizable number of the chronic cases — between 25 and 40 percent, depending on which studies you believe — can eventually develop into cirrhosis or liver cancer.

Shortly after he started serving his latest sentence, Deaguero complained of symptoms of a hep C flare-up: chronic fatigue, aching muscles and joints, a constant throbbing pain in his lower back. He went to the prison infirmary for tests and was told that there were new wonder drugs coming on the market that could actually cure hep C, in more than 95 percent of the cases treated. But before he could qualify for the medication, the Colorado Department of Corrections required that he take alcohol- and drug-education programs that can last from six months to a year.

Deaguero took the programs. Last spring he contacted the prison medical providers again to ask when he could start taking the cure. He was told he didn’t qualify for treatment. The new drugs are obscenely expensive — at full retail value, as much as $1,100 a pill, or $95,000 for one patient’s daily dosages over twelve weeks. According to DOC standards, Deaguero’s liver wasn’t damaged enough yet to justify the expense. Medical staff would continue to monitor him, and if tests indicated that his condition had worsened to a sufficient degree, he would then become eligible for treatment.

Deaguero filed a grievance, arguing that it would be better to treat him now rather than risk further damage and possibly the $500,000 cost of a liver transplant down the road. “To invest in my treatment now would make a lot of sense at this point in my life,” he wrote. “Not when it’s too late.”

His grievance was denied. He is now appealing. “They provide the least treatment possible, and it takes forever to be seen,” he says. “I understand it’s expensive. So is treating cancer, but the DOC does it. They are not consistent on how they grant treatment.”

Complaints about the prison system’s severely rationed approach to treating hep C aren’t confined to Deaguero. Many of the 2,200 inmates in DOC who’ve been diagnosed with hep C worry about not only worsening aches and inflamed livers, but also their one-in-five odds of a protracted, agonizing death from cirrhosis and organ failure. “I am aware of four others just in my living unit that have hep C and are in the same situation as me,” says 61-year-old John Spring, who was diagnosed with the virus in 2005 and has been approved for monitoring but not treatment. “I know of three inmates who have died because the DOC did not treat them or delayed their treatment.”