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Identification and Clinical Management of Persons with Chronic Hepatitis C Virus Infection - Cherokee Nation, 2012-2015
- Source :
- MMWR. Morbidity and mortality weekly report. 65(18)
- Publication Year :
- 2016
-
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.
- 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
Subjects
Details
- ISSN :
- 1545861X
- Volume :
- 65
- Issue :
- 18
- Database :
- OpenAIRE
- Journal :
- MMWR. Morbidity and mortality weekly report
- Accession number :
- edsair.doi.dedup.....e7529d6aa19f948adc19bd24c0424ed0