Monitoring the Hepatitis C Epidemic in the United States: What Tools Are Needed to Achieve Elimination
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WASHINGTON (June 13, 2017) — With a growing consensus in the global health community that Hepatitis C (HCV) could be eliminated, a new report from the O’Neill Institute for National and Global Health Law at Georgetown University highlights a key missing element needed to achieving complete elimination-adequate surveillance and monitoring-and explains how modest investments would improve lives and save money. The report was published June 13 ahead of the National Viral Hepatitis Roundtable congressional briefing June 14.
The Centers for Disease Control and Prevention (CDC) estimates that at least 3.5 million Americans currently have HCV infection, and rates of new infections have increased nearly 2.9-fold between 2010 and 2015. The latest data from 2015 indicate that an estimated 33,900 new infections occurred that year alone.
The report, “Monitoring the Hepatitis C Epidemic in the United States: What Tools are Needed to Achieve Elimination?” explains that effective medicines are available to treat and often cure hepatitis C, but information is lacking to know where to “deploy critical public health and health care resources to prevent new infections, screen and diagnose cases, and treat all of those who are infected with the virus,” write the authors.
Written by Institute Associate Sonia L. Canzater, JD, MPH and Jeffrey S. Crowley, MPH, program director of infectious disease initiatives and distinguished scholar at the O’Neill Institute, the report was developed following an expert consultation held in Washington, DC, in September 2016 with diverse stakeholders, including hepatitis C medical and non-medical providers, patient advocates, epidemiologists, and federal hepatitis C policy and program staff.
Crowley and Canzater identify five critical actions that should be priorities for monitoring HCV: 1) expand and standardize reporting to the CDC, 2) utilize electronic medical records to collect data on HCV cases and the cure cascade, 3) fund epidemiologic research using clinical data sets, 4) integrate improved monitoring of HCV with responses to the opioid epidemic, and 5) establish and monitor HCV elimination plans across major US health systems.
“Even with a constrained federal budget, more resources are needed for HCV surveillance and monitoring,” Crowley said, adding, “Relatively modest investments, however, can have a big impact toward eliminating HCV.”
Canzater said that, “Most of the newly infected HCV cases are among injection opioid drug users, but we often do not have even basic information to adequately monitor where and how the HCV epidemic is unfolding in the US and we are not using the clinical data that is already collected.” Canzater and Crowley say eliminating HCV would lead to a plummet in liver cancer rates (HCV was responsible for half of the nearly 23,000 liver cancer deaths in 2010). Almost $300 million a year in health care costs could be saved by avoiding the liver transplant surgeries caused by HCV.
Canzater and Crowley conclude, “Unlike some pressing problems where the scope of need is so large it can be immobilizing, modest new investments can have a significant impact. Boosting the capacity to monitor the HCV epidemic can move the nation toward eliminating HCV as a public health threat in the United States.”
The report is available for free on the O’Neill Institute website.
This project is supported by funding from Gilead Sciences, Inc. Gilead had no editorial control over the content of the report. Crowley received an honorarium from Gilead for a speaking engagement unrelated to this report. Canzater reports no recent personal financial interests related to the report.
The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. Celebrating its 10th year in 2017, its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public’s health, using objective evidence as a measure. The O’Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.