Researchers: Hepatitis C virus control needs a public health approach

A public health approach is necessary to identify and treat hepatitis C virus (HCV)-infected individuals and prevent new infections, according to a new study.

“We believe that the success of public health interventions, such as those for tuberculosis, can be translated to HCV infection,” lead author Fabienne Laraque, MD, MPH, medical director of the New York City Department of Homeless Services/Department of Social Services, told Medical Economics.

The researchers published their results in June 2017, American Journal of Public Health.

In the U.S., HCV transmission primarily occurs through needle sharing and other illicit drug use. However, “screening for HCV infection using risk behaviors such as drug use is inadequate for identifying the majority of patients because of provider reluctance to ask about risky behaviors and patient lack of recall or fear of stigma,” said Laraque.

HCV infection could be eliminated with a concerted public health effort and liberal access to the latest treatments, according to the researchers. Successful treatment of HCV infection results in lifelong cure, decreases the risk of associated liver diseases, decreases liver-related and all-cause mortality and reduces costs to the healthcare system, she said.

The current New York City strategy has led to improvements in the treatment and cure of HCV-infected patients. The city has instituted an HCV surveillance system from laboratory reports in real time that includes patient identifiers. Surveillance data showed that more than 40% of patients did not undergo confirmatory RNA testing after a positive antibody screening test. “We worked with providers to increase the proportion of patients tested and with commercial clinical laboratories to promote reflex RNA testing,” said Laraque.

Next: HCV screening makes a difference

In 2014, the city health code mandated the reporting of negative HCV RNA test results, and that data is now used to estimate the proportion of successfully treated patients. The Department of Health and Mental Hygiene also began HCV screening in sexually transmitted infection clinics and promoted screening in emergency departments. Recently, a care coordination program for HIV was adapted for HCV patients.

HCV management and treatment have traditionally been confined to specialists. “With simpler treatments now recommended for all people with HCV infection, the number of physicians prepared, competent, and willing to treat HCV infection is too low to meet the demand,” said Laraque, who noted New York State only has about 40 dedicated hepatologists.

Although it is unlikely that every primary care provider will have the capacity to treat HCV infection, all licensed healthcare providers should know how to screen for and confirm HCV infection, she said. Training materials are distributed to assist all New York City-based providers with HCV screening and diagnosis, including a toolkit for screening with links to care and guidance for diagnosing and managing HCV infection.

To reduce illness and death stemming from HCV infection on a national scale, “health departments need to adopt, disseminate and support a public health approach to HCV infection control,” said Laraque.