January 16, 2014

HCV: who/how to screen - HCV is a Disease of the Marginalized

from Jules Levin, NATAP

READ THE NUMBERS. THE MARGINALIZED populations estimated to have HCV make up a LARGER proportion than you think. If you read the articles/reports in these links you will see the disproportionate affect of HCV in marginalized patient populations. If you closely look at the data on who has HCV, the new NHANES survey just published linked to below, and then compare that to the large prevalence of HCV in the marginalized communities, it is clear that these marginalized communities are more key & need special attention including because they are harder to reach but also because numerically they are more critical than you think. I think a larger focus for awareness, linkage to care & care must be on marginalized populations if we are to hope to uncover all those with us diagnosed HCV. The 1.5-2% prevalence in the general population in the USA referred to in the new NHANES report below is likely an overestimate for the impact on individuals not a member of these identified marginalized populations, so this says screening and awareness projects need to focus and target on these marginalized pops! This changes the thinking regarding how to diagnose the undiagonsed! what methods to use! it's not just about general awareness. We need targeted outreach awareness & screening based on patient group characteristics: homeless, IDUs, prisoners, Latinos, African-Americans, immigrants (Russians, Indian peninsula, East Asia etc), which will bring increased effectiveness, support programs are necessary to achieve ultimate success of cure, i.e. linkage to care, treatment support. In marginalized communities (IDUs, African-Americans, Latinos) many do not know where to go for screening so what is needed is culturally appropriate awareness telling people exactly where to go for screening, then you need direct linkage to care, preferably with an on-site case mgr, because it is too often too difficult for many of these individuals to navigate the healthcare system, many of them are alienated from the healthcare system, they may not have ever been to a doctor or very infrequent, often he healthcare system is not friendly to them. Then of course for certain IDU populations and other marginalized patient populations you need care situations in which they feel comfortable, that welcomes them & works for their situations. The HCV affected populations are very segmented & awareness/outreach programs need to be very much tailored to them specifically based on culture, neighborhood, and life-experiences. General awareness programs to "baby boomers" will miss this. General awareness programs to "baby boomers" will miss this. Outreach in HCV is similar to advertising a consumer product like soap, the markets are highly segmented & you must tailor "advertising"/outreach based on these segmented populations you are trying to reach.

How Many/Who HAS HCV in USA - (01/14/14) ....

[HCV Heterogeneity among various Latino groups] Prevalence of Hepatitis C Virus Infection in US Hispanic/Latino Adults: Results from the NHANES 2007-2010 and HCHS/SOL Studies - (01/15/14)

New NHANES: The Changing Epidemiology of Hepatitis C Virus Infection in the United States: National Health and Nutrition Examination Survey 2001 through 2010 - (01/13/14)

HepC

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