PHC Impacts Hepatitis C Surveillance!

Hepatitis C is a blood-borne infection of the liver that results from the hepatitis C virus (HCV). Approximately 2.7 million persons in the United States have chronic hepatitis C virus infection. Chronic hepatitis C can cause serious health problems including liver disease, liver failure, and even liver cancer. An acute infection can range from mild illness to a serious condition requiring hospitalization. The number of acute cases of hepatitis C reported in the US increased from, 1,778 in 2012 to 2,138 in 2013. We know that hepatitis C is under-reported due to asymptomatic cases and surveillance barriers.

This year is a particularly important year for a renewed effort in hepatitis C surveillance by the Allegheny County Health Department. In 2013 the FDA approved a cure for hepatitis C. Sofosbuvir, one of the new HCV drugs on the market, comes in an easy once-a-day pill. It takes as few as 12 weeks to work, and it cures up to 90% of people who take it. The down-side to the treatment is that it is prohibitively expensive, and it is difficult for insurance to cover. Each pill costs about $1,000, which totals upwards of $84,000 for treatment. Insurance companies have stipulations that make it challenging for patients to receive care. Pennsylvania’s Medicaid covers Sofosbuvir if the patient has an F3 or F4 stage of liver fibrosis and demonstrates a record of at least 6 months abstinence from drugs and alcohol. These adherence criteria prevent HCV-infected patients with healthy livers, who want to prevent liver damage, from receiving treatment. It also limits IVDU (intra-venous drug users) from accessing care. IVDU patients are among the highest risk population for contracting and spreading HCV.

Through my service as a Disease Surveillance specialist, I ascertain the disease burden for the county, as well as link patients to services. The status quo for hepatitis C right now is bleak. Navigating the system is challenging enough, and many patients don’t know where to start. Health departments are overwhelmed and inadequately equipped to respond to the epidemic. When I call patients, not only am I collecting information to help the Health Department get a better picture of the problem, I’m also enabling patients to seek treatment by providing education and resources. Slowly, the culture of confusion and hopelessness dissipates when patients know that there is a cure.

My favorite part of the process is the opportunities for expanding my knowledge of surveillance and how health departments respond to epidemics. This enhanced HCV surveillance initiative is new to the Health Department and new to me as well. I had the opportunity to learn from a team of investigators at the Philadelphia Department of Public Health, who had the ability to make house-calls and conduct more in-depth investigations for HCV surveillance thanks to grant-funding from the CDC.  While sitting in my cubicle I tackled a year’s worth of data as the sole HCV investigator at ACHD. Needless to say, it took a lot of teamwork with the ACHD team and community partners in order for me to learn this new service and develop a serviceable system of surveillance on limited resources. As per the spirit of AmeriCorps, ACHD is getting it done! In April, we had an HCV meeting with stakeholders and specialists in the area to address HCV surveillance. In September, I will attend an HCV Summit organized by the PA Department of Health, ACHD, and the Community Liver Alliance.

I am looking forward to making this year a good year for surveillance!