Hepatitis C virus prevention, care, and treatment: from policy to practice.

Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 07/2012; 55 Suppl 1:S58-63. DOI: 10.1093/cid/cis392
Source: PubMed

ABSTRACT The prevention of hepatitis C virus (HCV) infection and associated health conditions (eg, cirrhosis and hepatocellular carcinoma) is a public health priority in the United States. Hepatitis C virus-related morbidity and mortality is increasing at a time when the advent of highly effective therapies greatly increases opportunities to prevent HCV transmission and disease. In 2010, the Institute of Medicine recommended that national action be taken to address this "underappreciated health concern for the nation." In response, in 2011, the US Department of Health and Human Services (HHS) published a viral hepatitis action plan that guides response to the viral hepatitis epidemic by providing explicit steps to be undertaken by specific HHS agencies to improve provider training and community education; expand access to testing, care, and treatment; strengthen public health surveillance; improve HCV preventive services for injection drug users; develop a hepatitis C vaccine; and prevent HCV transmission in healthcare settings. For all aspects of the action plan, infectious disease specialists and other clinicians assume a key role in efforts to reduce HCV-related morbidity and mortality. With successful collaboration of the public and private sectors, the hepatitis C epidemic can be forever silenced.

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    ABSTRACT: Background. Hepatitis C virus (HCV) infection is a major public health problem in the United States. Although prior studies have evaluated the HCV-related healthcare burden, these studies examined a single treatment setting and did not account for the growing "baby boomer" population (individuals born during 1945-1965). Methods. Data from the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, and the Nationwide Inpatient Sample were analyzed. We sought to characterize healthcare utilization by individuals infected with HCV in the United States, examining adult (>= 18 years) outpatient, emergency department (ED), and inpatient visits among individuals with HCV diagnosis for the period 2001-2010. Key subgroups included persons born before 1945 (older), between 1945 and 1965 (baby boomer), and after 1965 (younger). Results. Individuals with HCV infection were responsible for >2.3 million outpatient, 73 000 ED, and 475 000 inpatient visits annually. Persons in the baby boomer cohort accounted for 72.5%, 67.6%, and 70.7% of care episodes in these settings, respectively. Whereas the number of outpatient visits remained stable during the study period, inpatient admissions among HCV-infected baby boomers increased by >60%. Inpatient stays totaled 2.8 million days and cost >$15 billion annually. Nonwhites, uninsured individuals, and individuals receiving publicly funded health insurance were disproportionately affected in all healthcare settings. Conclusions. Individuals with HCV infection are large users of outpatient, ED, and inpatient health services. Resource use is highest and increasing in the baby boomer generation. These observations illuminate the public health burden of HCV infection in the United States.
    Clinical Infectious Diseases 06/2014; 59(6). DOI:10.1093/cid/ciu427 · 9.42 Impact Factor
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    ABSTRACT: The majority of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection occurs among persons who inject drugs. Rapid improvements in responses to HCV therapy have been observed, but liver-related morbidity rates remain high, given notoriously low uptake of HCV treatment. Advances in HCV therapy will have a limited impact on the burden of HCV-related disease at the population-level unless barriers to HCV education, screening, evaluation, and treatment are addressed and treatment uptake increases. This review will outline barriers to HCV care in HCV/HIV coinfection, with a particular emphasis on persons who inject drugs, proposing strategies to enhance HCV treatment uptake and outcomes.
    The Journal of Infectious Diseases 03/2013; 207(1):19-25. DOI:10.1093/infdis/jis928 · 5.78 Impact Factor
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    ABSTRACT: Improved drugs have been approved for the treatment of hepatitis C virus (HCV), but many people are unaware of improved therapies that are now available to cure the illness in a high percentage of patients. The objectives of the Test, Listen, Cure (TLC) Hepatitis C Community Awareness Campaign include the development and implementation of a health education and promotion campaign in Memphis, Tennessee, and surrounding areas of western Tennessee, eastern Arkansas, and northern Mississippi, to increase community awareness about HCV, and to provide up-to-date provider education on HCV screening and treatment. The health education and promotion campaign, which will be conducted in collaboration with area hospitals, clinics, and nonprofit organizations, will provide information about how HCV infection is transmitted, risk factors for the disease, the importance of screening and treatment, and the availability of improved treatment for the disease. A second objective will be to provide continuing professional education on HCV screening and treatment to a minimum of 200 area health care providers, including primary care and internal medicine physicians and residents, physician assistants, nurse practitioners, providers who care for homeless persons, and dialysis unit nurses. Health education materials will be developed for this community awareness campaign that is culturally appropriate for African Americans and suitable for people with lower health literacy and educational attainment. Information will be compiled and disseminated about area providers who provide screening services and treatment for persons with HCV in order to facilitate linkages to care. Four focus groups of 8-10, African American adults aged 40-64, will be conducted to test the health education materials. The provider education on HCV will also address patient-physician communication and cultural competency. The National Medical Association regional chapters and expert physician consultants will provide assistance with delivering the education program. Results from this one year project will be available in early 2016. Depending on the availability of funding and successful implementation of the project, the TLC campaign will be extended to similar cities in the United States.
    02/2015; 4(1):e13. DOI:10.2196/resprot.3822



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