Hepatitis C and the Ryan White Program
Hepatitis C and the Ryan White Program
Anywhere from 25-35 percent of the 1.1 million Americans infected with HIV/AIDS are coinfected with hepatitis C virus (HCV). That's around 300,000 people. Infection rates are much higher among certain subpopulations of HIV-infected individuals, such as injection drug users. Liver disease that is tied to HCV infection is a leading cause of death among HIV-infected individuals.
Ryan White-funded clinics around the Nation are responding to these needs by taking on a greater role in HCV care. Much of the work of Ryan White grantees has focused on helping clients manage HCV infection by providing, for example, alcohol counseling to coinfected clients. However, clinics are increasingly looking for ways to take the next step and deliver HCV treatment, which was once considered too toxic and risky but is less so given new and emerging HCV drug regimens. Indeed, there is greater attention to viral hepatitis B and C across the board under the National Viral Action Plan, released May 12, 2011.
All Ryan White clinics should be monitoring HCV disease among their coinfected patients and evaluating them for potential HCV treatment.
What stands in the way of more clinic sites taking on HCV care? HCV care is expensive. Reimbursement sources are limited. Many clinics lack knowledge about and infrastructure to deliver HCV services. Some sites are reluctant to tackle HCV treatment with patients perceived to be poor candidates for treatment adherence. For these reasons, coinfected individuals face serious gaps when it comes to getting treatment for HCV infection.
Technical Guidance on HCV/HIV Care
HRSA's HIV/AIDS Bureau (HRSA/HAB) is providing technical support to grantees to help them expand HCV care and treatment services. In 2011, multiple HCV/HIV protocols and tools were issued by HRSA and more are to come (see sidebar). In 2010, HAB's performance measures added four hepatitis-related measures: hepatitis B vaccination, hepatitis B screening, hepatitis C screening, and hepatitis/ HIV Alcohol Counseling. Also in 2010, grantees around the country shared insights on HCV/HIV care in workshops at the Ryan White Grantee Meeting, available in the TA Library. In coming years, more insights on HCV/HIV care are expected from the HCV Hepatitis C Treatment Expansion Initiative under the Special Projects of National Significance (SPNS), which has funded 30 projects around the Nation and will run from 2011-2013.
The above efforts come on the heels of HRSA/HAB efforts over the past five years to increase Ryan White program attention to hepatitis. Early efforts included a 2006 report on expanding HCV/HIV access and a 2007 national teleconference on this same topic. These early initiatives were carried out in concert with 2006 and 2009 Ryan White legislative amendments that increased the Ryan White focus on hepatitis B and C, such as requirements for Part A planning councils to include coinfected individuals among their membership and identification of hepatitis services and coinfected persons as areas for attention by funded programs.
National Hepatitis Action Plan
From 3.5 to 5.3 million people in the United States are infected with viral hepatitis. See Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care and Treatment of Viral Hepatitis.
Hepatitis C Resources
- A Guide for Evaluation and Treatment of Hepatitis C in Adults Coinfected with HIV.
- Integrating Hepatitis C Treatment in Ryan White Clinics: Models & Steps.
- HAB Performance Measures. Indicators for use in monitoring the quality of care include measures on hepatitis B vaccination, hepatitis B and C screening and hepatitis/HIV Alcohol Counseling.
- Guide for HIV/AIDS Clinical Care (January 2011). The HCV chapter is just one of the 93 topics covered over 610 pages. See the guide along with the full set of HRSA HIV/AIDS Bureau clinical protocols, which complement guidelines.
- The AETC National Resource Center's Hepatitis Coinfection Page has an extensive collection of Web Resources on Hepatitis Coinfection.