Indian Health Service highlights Hepatitis Awareness Month
By Matthew Hudson MD, MPH, preventive medicine fellow, Johns Hopkins School of Bloomberg School of Public Health
The Indian Health Service is committed to eliminating hepatitis C in Indian Country, and we are successfully overcoming the obstacles in the way of achieving this goal. Hepatitis C is a serious liver disease that results from infection with the Hepatitis C virus, or HCV. We know that at least 30,000 American Indian and Alaska Native individuals have been diagnosed with hepatitis C, which can lead to chronic liver disease, cirrhosis, and liver cancer. Tens of thousands of American Indian and Alaska Native people may have HCV and not even know their status. Fortunately, the overwhelming majority of the men and women with chronic hepatitis C can now be cured—often in as little as two months with new generations of pills that have few, if any, side effects. Even if past medications have failed, the latest treatments have a very high likelihood of working. But there’s a catch— we have to screen patients for HCV and get them into treatment.
In November 2018, the IHS National Pharmacy and Therapeutics Committee added three different HCV treatments to the agency’s National Core Formulary, meaning that these medications can now be accessed at all IHS facilities. IHS and tribal clinicians have used in-person training and video conferencing support to gain the expertise needed to start HCV treatment protocols in areas of the country where liver specialists are not available. This support comes from federal, tribal, and external experts such as specialists at the University of New Mexico’s Project ECHO and the University of California-San Francisco’s Clinical Consultation Center. Since January 2017, clinicians from 64 IHS, tribal, and urban Indian healthcare facilities (representing all 12 IHS areas) have received training through ECHO, and 37 facilities have initiated treatment for their patients. “As a result, over 500 American Indian and Alaska Native patients have received recommendations on Indian Country tele-ECHO clinics,” writes Northwest Portland Area Indian Health Board ECHO Clinical Director David Stephens.
IHS clinics have been working to help patients overcome additional barriers to successful treatment such as substance use disorders. “Many of our patients with substance use disorder had a difficult time making scheduled appointments, or following-up for lab tests or liver imaging, and were hard to contact after they left the clinic,” writes Dr. Justin Iwasaki, the special projects director at the Lummi Tribal Health Center. Keeping this in mind, Dr. Iwasaki and his colleagues redesigned the healthcare delivery model of Lummi’s HCV treatment program to expedite treatment. “Using a Single Visit Ready to Treat Model, which incorporates bundled lab ordering and on-site imaging, we were able to meet the needs of our patients by providing nearly all of the HCV diagnosis and staging elements of HCV treatment in one visit,” Iwasaki writes. The results have been outstanding—in a little over 2 1/2 years the Lummi Tribal Health Center has treated over 100 patients under this model.
The IHS is committed to stopping the spread of HCV in American Indian and Alaska Native communities. I urge you to get the message out to your friends, family, and get tested for HCV yourself, it can save your life.