August 16, 2021 at 5:00 am ET
Beyond the critical discussions in Washington about how to make medicines more accessible for patients is the challenge in identifying, reaching and treating vulnerable communities. The rollout of COVID-19 vaccines reminds us that those access, outreach, and education issues are critical in engaging communities in order to slow the spread of infectious disease.
The hepatitis C virus is no exception, and we must empower communities and providers to effectively engage HCV patients and at-risk populations, work toward improving patient outcomes and ultimately end the epidemic. Alongside efforts to improve HCV treatment affordability and accessibility, Congress should recognize the immediate need and opportunity to expand access to HCV testing, prevention and education services for those most at risk of contracting the virus – and it starts with allocating proper funding.
As many as 4.7 million people are living with hepatitis C in the United States today, and 51 percent of them are unaware that they have the virus. Those who don’t know their HCV status are at risk for life-threatening liver disease, cancers and unsuspectingly transmitting the virus on to others. Alongside delays in critical routine health care services that many faced during the height of the COVID-19 pandemic, the United States remains behind on identifying those affected by HCV and getting them the necessary treatment and care.
Here’s the good news: We already have a cure for nearly all HCV infections. Through an eight- or 12-week treatment regimen, direct acting antiviral medications significantly improve patient health and quality of life and reduce mortality from liver failure, cancer, and other liver-related conditions. Today, about 95 percent of HCV patients who are treated with DAAs are cured. And while efforts continue to improve affordability of effective DAAs used to treat and cure hepatitis C, the trends tell us market competition is working to help decrease costs for patients who today have more generic treatment options available to them. Unfortunately, cost remains an intersectional issue in overcoming barriers to get more patients connected to the care and supportive services needed.
New evidence from HealthHCV’s Fourth Annual State of HCV Care National Survey tells us about 1 in 3 providers is unable to treat a patient with HCV due to payer or insurance limitations and restrictions. Many HCV service providers are also failing to implement Centers for Disease Control and Prevention screening recommendations for HCV, with less than half of providers screening some of the most vulnerable populations – including those with a substance use disorder, patients living with HIV and baby boomers born between 1945 and 1965. Patients can also experience lengthy prior authorizations and pre-approvals, which may turn them away from accessing necessary care for their condition. And even when patients are given access to testing, many drop out of care following diagnosis – especially patients who are also being treated for substance abuse.
HCV elimination will only be possible if we have comprehensive federal and state plans that address the intersections of opioid use disorder, hepatitis C, HIV and sexually transmitted infections across the United States. It starts with making the proper investments to address community engagement and access barriers. We need to build a public health infrastructure to reach at-risk populations where they are and increase HCV screening in HIV care and treatment programs, substance abuse centers, needle exchange centers and private practices – especially in rural and underserved communities.
Today, the CDC’s viral hepatitis program — which oversees the country’s surveillance, prevention, testing, and linkage to care activities — receives just a tenth of the estimated funding needed to eradicate the disease, or $39.5 million per year. That is simply not good enough to achieve elimination, and points to the need for Congress to fully fund and implement the Viral Hepatitis National Strategic Plan: A RoadMap to Elimination 2021-2025. Unfortunately, President Biden’s fiscal year 2022 budget for CDC falls short of the HCV community’s request of $134 million for the CDC Hepatitis Division.
The story of HCV reminds us that while effective treatments are available, patients most at risk are not receiving them. Unless we address outstanding access barriers to testing, treatment, care and the necessary supportive services, we will continue to leave those who are unknowingly living with HCV behind. Congress and the Biden administration should act and recognize the crucial need to adequately fund efforts to eliminate the virus. If proper funding is allocated, we can draw closer to testing, treating and curing all vulnerable Americans for HCV.
Brian Hujdich is the executive director of HealthHIV, one of the largest national HIV non-profit organizations, which also runs the HealthHCV initiative and the National Coalition for LGBT Health.
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