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It Starts With Us: Providers as Advocates for Vulnerable Persons With HCV

Oluwaseun Falade-Nwulia, MBBS, MPH

Associate Professor
Division of Infectious Diseases
Johns Hopkins University School of Medicine
Division of Infectious Diseases
Johns Hopkins Hospital
Baltimore, Maryland

Oluwaseun Falade-Nwulia, MBBS, MPH, has no relevant conflicts of interest to report.

View ClinicalThoughts from this Author

Released: December 18, 2019

As the elimination of hepatitis C as a public health threat is within reach, increasing rates of HCV testing and linkage to care have been key. Since there are no “one size fits all” strategies, beyond treatment and cure, we also need to think about ways to preserve the benefits of HCV cure by preventing reinfection and untimely deaths related to opioid overdose.

In the United States, hepatitis C disproportionately affects people who use drugs and incarcerated individuals. Approaches to HCV elimination in these groups will require simplification of treatment strategies to expand the pool of HCV treatment providers and treatment support in diverse settings, including in drug treatment centers and prisons.

It will also require integration of evidence-based interventions such as access to syringe service programs, opioid agonist therapy for opioid use disorder treatment, naloxone for overdose prevention, and HIV testing, all of which can reduce the harmful consequences of ongoing substance use.

Integrating Harm Reduction Into HCV Care
Recent updates to guidelines such as the AALSD/IDSA HCV recommendations can be easily referenced to provide simplified HCV treatment strategies. However, an outstanding question remains: As extremely busy clinicians, how do we find time to integrate harm reduction into HCV care provision?

The availability of electronic prescribing may make it easier for us to prescribe naloxone when we order HCV laboratory tests or HCV treatment. Some of us may consider creating a harm reduction order set so that, with one simple click, we can prescribe naloxone and/or refer patients with a history of substance use to opioid agonist treatment.

Some of us may be in a position to advocate for the reform of policies related to the health of persons who use drugs. We can advocate to remove laws that restrict syringe service program access, that implement substance use requirements for HCV treatment access, or that otherwise prevent access to treatment for substance use disorder. 

Increasing Access to HCV Treatment in Jails and Prisons
How do we get HCV treatment into our jails and prisons? Who will pay for these treatments? It’s going to take some work and it’s going to take all of us.

Public–private partnership models have recently been implemented in Louisiana and Washington that allow the states to pay a flat fee for unlimited drugs to treat people who are in prison and/or enrolled in Medicaid. These programs show us that it could be possible to get access to therapy for all those infected with HCV.

What is going to work in your state? Who needs to be at the table to start the discussions that will lead to a successful pathway to HCV therapy for everyone in your state?

Advancing progress toward HCV elimination will also require destigmatization of hepatitis C and substance use disorders. HCV infection and substance use disorders are medical conditions with effective medical treatments. Stigma and criminalization of drug use only hamper our ability to link vulnerable populations in most need of therapy to testing and treatment.

We must work to reduce stigma and discrimination related to hepatitis C and substance use in our individual clinics and our communities—it starts with each of us!

Your Thoughts?
How can you act as an advocate for vulnerable populations with HCV? Please tell us your thoughts in the comment box below. For more information on these and other topics related to liver health, see our program based on a live symposium presented by me and my colleagues, Paul Y. Kwo, MD, and Manal F. Abdelmalek MD, MPH.

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