Hepatitis and HIV Care
Hepatitis and HIV Care
Hepatitis is widespread, deadly, and yet, largely preventable. In the United States, chronic viral hepatitis (hepatitis B and C) affects 3.4-5.3 million people. Most do not know they are infected. Hepatitis is the leading cause of liver transplants in the United States, and it accounts for 12,000-18,000 deaths annually. Worldwide, 130-150 million are infected with HCV, with 350,000 to 500,000 deaths each year.
CDC: Hepatitis Kills More Americans Than Any Other Infectious Disease (5/4/16). Take the Hepatitis Risk Assessment and learn more about Viral Hepatitis from CDC.
For people living with HIV/AIDS, the impact of hepatitis is more severe. An estimated 33% of persons living with HIV are coinfected with the hepatitis B virus (HBV) or hepatitis C virus (HCV), while about one fourth are HCV/HIV coinfected (June 2016). According to CDC, "liver disease—much of which is related to HCV and HBV—has become the leading cause of non-AIDS-related deaths" among people living with HIV/AIDS.
Hepatitis management is increasingly within our grasp, given vaccinations, more widespread screening to identify infected individuals, and new treatments--in particular, a new generation of HCV treatments approved in 2013 that has a very high cure rate. SYet, significant challenges exist, from mobilizing health systems to screen and vaccinate to the high cost of HCV medications. The framework for confronting hepatitis is outlined in the National Viral Hepatitis Action Plan 2017-2020, an update of 2014 and 2011 versions, with goals and priorities on testing to inform infected individuals of their status, care and treatment for infected persons, preventive work to reduce new cases, and elimination of mother-to-child transmission.
Guidance on hepatitis care and treatment has been produced in multiple HRSA documents, including the comprehensive Guide for HIV/AIDS Clinical Care's chapter covering hepatitis B and C, Guide for HIV/AIDS Clinical Care: Comorbidities, Coinfections, and Complications. See also Hepatitis C Online for clinician course modules on HCV, a complete list of HCV treatments and more.
Ryan White and Hepatitis Care, Data and Monitoring
HRSA and Ryan White entities have been working on hepatitis initiatives for many years. Some of the earlier work is described in this 2013 AIDS.gov blog while more recent activities include:
- The SPNS research and demonstration project Hepatitis C Treatment Expansion Initiative, which focused on development of replicable HCV treatment models within HIV primary care programs. Lessons learned have been turned into training materials and a curriculum under HRSA's IHIP, Integrating HIV Innovative Practices.
- The latest HRSA HCV inititiave is Jurisdictional Approach to Curing Hepatitis C among HIV/HCV Coinfected People of Color, funded in late 2016 to improve hepatitis C virus services among HIV/HCV co-infected people of color, funded under the FY 2016 Secretary’s Minority AIDS Initiative Fund.
The HRSA HIV/AIDS Bureau has created a framework of resources to support Ryan White programs in monitoring the delivery of HIV care, inclusive of hepatitis. HAB's Performance Measures are comprised of multiple sets, with an adolescent/adult set of measures that include specific measures addressing hepatitis B screening and vaccination and hepatitis C screening. On the data end, HRSA's Ryan White Services Report, the RSR client-level data system, is used by grantees and funded providers to collect the same performance measure data, above, on hepatitis B screening and vaccination as well as hepatitis screening.