1. Identification and Clinical Management of Persons with Chronic Hepatitis C Virus Infection - Cherokee Nation, 2012-2015
- Author
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John W. Ward, David Gahn, Douglas A. Drevets, Jorge Mera, Whitney Essex, Lisa Lyons, Brigg Reilley, Susan Hariri, Hélène Carabin, Jessica Leston, Anna Miller, and Claudia Vellozzi
- Subjects
Gerontology ,Adult ,Male ,medicine.medical_specialty ,Health (social science) ,Epidemiology ,Health, Toxicology and Mutagenesis ,Hepatitis C virus ,Population ,Hepacivirus ,medicine.disease_cause ,Antiviral Agents ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Health Information Management ,Internal medicine ,medicine ,Humans ,Mass Screening ,030212 general & internal medicine ,education ,Mass screening ,Aged ,education.field_of_study ,business.industry ,Incidence (epidemiology) ,virus diseases ,General Medicine ,Hepatitis C ,Health Status Disparities ,Hepatitis C Antibodies ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,digestive system diseases ,Organizational Policy ,United States ,Chronic infection ,Cohort ,United States Indian Health Service ,Indians, North American ,RNA, Viral ,030211 gastroenterology & hepatology ,Female ,business ,Cohort study - Abstract
An estimated 3.5 million persons in the United States are living with hepatitis C virus (HCV) infection, resulting in approximately 20,000 deaths each year, primarily from cirrhosis or hepatocellular carcinoma (1,2). American Indian/Alaska Native (AI/AN) populations have the highest incidence of acute HCV infection among all U.S. racial/ethnic groups and are at greater risk for HCV-related mortality compared with the general population (3). In 2013, new antiviral drugs became available that make possible 8-12 week treatment regimens with fewer adverse events and are able to achieve sustained virologic response (SVR) in >90% of treated patients (4), equivalent to a cure of HCV infection. Also of note, HCV testing recommendations were expanded in 2012 by CDC and in 2013 by the U.S. Preventive Services Task Force to include one-time testing of persons born during 1945-1965 (the "baby boomer" cohort) in addition to anyone at increased risk for HCV infection (5,6). Given the availability of new HCV drugs, expanded testing recommendations, and high incidence of HCV infection in AI/AN populations, in October 2012, Cherokee Nation Health Services (CNHS) implemented a tribal HCV testing policy.* As part of the policy, CNHS added a reminder in the electronic health record (EHR) for clinical decision support and provided HCV education to primary care clinicians. From October 2012 to July 2015, among 92,012 persons with at least one CNHS clinic encounter, the cumulative number who received HCV screening for the first time increased from 3,337 (3.6%) to 16,772 (18.2%). The largest percentage of HCV screening was among persons born during 1945-1965. Of 715 persons who tested positive for HCV antibodies, 488 (68.3%) were tested for HCV RNA; among those 488 persons, 388 (79.5%) were RNA positive and were thus confirmed to have chronic HCV infection. Treatment was initiated for 223 (57.5%) of the 388 with chronic infection; 201 (90.1%) completed treatment, of whom 180 (89.6%) achieved SVR. CNHS has successfully increased HCV testing and treatment and is now collaborating with CDC and other external partners to develop an HCV elimination program for the Cherokee Nation that might serve as a model for similar settings.
- Published
- 2016