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Injection behaviors among injection drug users in treatment: The role of hepatitis C awareness - Does HCV+ Awareness Among IDUs Reduce Needle Sharing

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Does HCV+ Awareness Among IDUs Reduce Needle Sharing? This study found NO - ."In adjusted analysis (Table 2), recent syringe/needle sharing was more likely among those who reported they were HCV-positive compared with those who were HCV negative/unaware (aOR 2.37 [95% CI 1.15, 4.88]), and among IDUs obtaining needles from the street, using any opioids, marijuana, or injected crack cocaine; sharing was less likely among males and participants with some college education......More HCV-positive IDUs reported recent syringe/needle sharing compared with those with HCV negative/unknown status (44.6% vs. 38.5%, p = .131), though this was not statistically significant"

from Jules: with the advent & revolution of new HCV oral & interferon-free therapy it will be important to provide education to at-risk patients about the risks for-re-infection with HCV. It is important to provide treatment to IDUs as persons but also for society. All too often now treatment for IDUs is withheld for a number of reasons including because IDUs are at risk for continuing risky behavior, sharing unclean needles & getting re-infected. Instead treatment for IDUs should be viewed as important for the patient, for prevention, ad for society & treatment should be viewed as an opportunity to provide education about preventing re-infection, why & how the patient should not be re-infected. Often this means addressing the patient's risky behavior, which could be sharing used/unclean syringes for the IDU or continued risky sexual & drug behavior for MSM. In recent studies in NYC & in London re-infection was cited among MSM due to continued unsafe drug & sex behavior, in fact re-infection was reported to occur 2-3 times after successful treatment for some individuals. In recent studies re-infection among IDUs has been found often. With treatment & cure of HCV comes a responsibility that these at-risk individuals, IDUs or a history of IDU, are educated not to be re-infected. Resources are scarce and should not be wasted particularly in the developing & undeveloped world but also in Europe, the USA & the Western world, its possible that retreatment may be denied by government or payers.

High incidence of hepatitis C virus reinfection within a cohort of injecting drug users - (10/13/13)

HCV Reinfection - (10/11/13)

HCV superinfection and reinfection - Review - (10/10/13)

HCV reinfection incidence and treatment outcome among HIV-positive MSM in London - (06/17/13)

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Injection behaviors among injection drug users in treatment: The role of hepatitis C awareness

Highlights

->38.5% of 244 IDUs seeking treatment reported sharing needles/syringes. ->Only 46.9% of IDUs always used a sterile needle/syringe. ->37.7% of IDUs reported being HCV positive. ->HCV awareness was associated with increased risky injection behaviors. ->New HCV prevention interventions are needed for IDUs seeking treatment.

"one's belief about one's HCV status is conceptually more closely related to injection behaviors than biologically confirmed HCV status......IDUs may adopt more of a fatalistic attitude toward risky injection practices. Indeed, a recent synthesis of qualitative studies of HCV risk among IDUs identified risk ubiquity as a common theme, supporting a perception of HCV as "a risk accepted rather than avoided.....The observed multivariable association between knowledge of HCV status and syringe/needle sharing may reflect overall greater drug use severity among those who become HCV-infected rather than a causal pathway toward increased risky behaviors. Regardless, the association highlights the role of HCV awareness as a marker for IDUs in particular need of harm reduction interventions.....The observed association between HCV-awareness and increased needle/syringe sharing may reflect a complex cluster of characteristics among HCV-aware IDUs in this cross-sectional study. Our data support that HCV awareness is likely a marker for IDUs with greater addiction severity (e.g., increased heroin injection and methadone maintenance among HCV-aware), addiction duration (older age among HCV-aware), and increased opportunities for HCV testing (e.g., increased needle exchange program use among HCV-aware, many of which offer HCV testing)."

"Risky injection practices persist among IDUs, with rates in the current study consistent with those of other recent studies (Booth et al., 2011 and Centers for Disease Control and Prevention, 2009) and may partially explain persistently high HCV incidence among IDUs.......In adjusted analysis (Table 2), recent syringe/needle sharing was more likely among those who reported they were HCV-positive compared with those who were HCV negative/unaware (aOR 2.37 [95% CI 1.15, 4.88]), and among IDUs obtaining needles from the street, using any opioids, marijuana, or injected crack cocaine; sharing was less likely among males and participants with some college education......More HCV-positive IDUs reported recent syringe/needle sharing compared with those with HCV negative/unknown status (44.6% vs. 38.5%, p = .131), though this was not statistically significant......The majority of IDUs in the present study obtained needles from safe sources, including pharmacies and syringe exchange programs, as corroborated in surveys of IDUs in other U.S. cities with policies that increase availability of sterile needles and syringes......Despite this, fewer than half of IDUs reported always using a clean needle or consistently cleaning needles, indicating that needle re-use and lack of needle cleaning are common. Even among the minority of IDUs reporting consistent needle cleaning, sterilization techniques other than use of bleach were frequently employed, suggesting that renewed efforts are needed to promote harm reduction techniques among IDUs.......Participants who reported they were HCV positive differed in several important behaviors compared with their counterparts. HCV positive IDUs more frequently exhibited harm reduction behaviors such as obtaining needles from a syringe exchange program, cleaning needles with bleach, and avoiding drinking alcohol to intoxication, suggesting that awareness of HCV status may confer increased adoption of some protective behaviors. HCV positive IDUs, however, were also more likely to inject heroin and, in multivariable analysis, to share needles."

"This finding contrasts with a sero-survey of street-recruited IDUs in Denver from 1998 to 1999, where those with a previous HCV positive test reported less receptive syringe/needle sharing, sharing of drug paraphernalia, and safer injecting practices compared with those with unknown status who tested HCV-positive during the study (Kwiatkowski et al., 2002). It is possible that in populations where higher proportions of IDUs are aware they are HCV-positive, IDUs may adopt more of a fatalistic attitude toward risky injection practices. Indeed, a recent synthesis of qualitative studies of HCV risk among IDUs identified risk ubiquity as a common theme, supporting a perception of HCV as "a risk accepted rather than avoided" (Rhodes, Singer, Bourgois, Friedman, & Strathdee, 2005). This is consistent with findings from a multicenter study of Swedish IDUs, in which 74% of those HCV-aware shared needles compared with 68% of those with unknown status (Norden et al., 2009)."

Author's CONCLUSIONS: This study highlights the need for broadly implemented HCV prevention interventions for all IDUs seeking addiction treatment, and suggests such interventions might particularly decrease transmission behaviors by those aware of their HCV infection and prevent HCV infection in those HCV-negative/unaware. Research which prospectively studies the effect of HCV testing and notification on risk behavior could help further clarify the association between HCV awareness and risk behaviors. Interventions that could improve services for IDUs include those that explicitly and repeatedly educate IDUs about safer injection practices and the treatability of HCV, and those that integrate HCV testing and treatment with addiction treatment services. As HCV screening and treatment options advance, community based treatment programs have a greater opportunity to play a central role in reducing HCV transmission and engaging HCV-infected IDUs in treatment.

-------------------------------

Injection behaviors among injection drug users in treatment: The role of hepatitis C awareness

Addictive Behaviors April 2012

P. Todd Korthuis a,, Daniel J. Feaster b, Zoilyn L. Gomez b, Moupali Das c,d, Susan Tross e, Katharina Wiest f, Antoine Douaihy g, Raul N. Mandler h, James L. Sorensen c, Grant Colfax d, Dennis McCarty a, Stephanie E. Cohen d, Patricia E. Penn i, Diane Lape a, Lisa R. Metsch b
a Department of Medicine and Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
b Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, 1425 Northwest 10th Ave, 3rd floor, Miami, FL 33136, USA c University of California, San Francisco, 1001 Potero Ave., San Francisco, CA 94110, USA
d San Francisco Department of Public Health, 356 7th St., San Francisco, CA 94103, USA
e HIV Center For Clinical and Behavioral Studies, NYS Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
f CODA, 1027 East Burnside St., Portland, OR 97214, USA
g University of Pittsburgh School of Medicine, 3811 O'Hara St # 1059, Pittsburgh, PA 15213, USA
h National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892, USA
i La Frontera Arizona, 504 W. 29th St., Tucson, AZ 85713, USA

Abstract

Background

Injection drug use (IDU) is a primary vector for blood-borne infections. Awareness of Hepatitis C virus (HCV) infection status may affect risky injection behaviors. This study determines the prevalence of risky injection practices and examines associations between awareness of positive HCV status and risky injection behaviors.

Methods

We surveyed individuals seeking treatment for substance use at 12 community treatment programs as part of a national HIV screening trial conducted within the National Drug Abuse Treatment Clinical Trials Network. Participants reported socio-demographic characteristics, substance use, risk behaviors, and HCV status. We used multivariable logistic regression to test associations between participant characteristics and syringe/needle sharing.

Results

The 1281 participants included 244 (19.0%) individuals who reported injecting drugs in the past 6 months and 37.7% of IDUs reported being HCV positive. During the six months preceding baseline assessment, the majority of IDUs reported obtaining sterile syringes from pharmacies (51.6%) or syringe exchange programs (25.0%), but fewer than half of IDUs always used a sterile syringe (46.9%). More than one-third (38.5%) shared syringe/needles with another injector in the past 6 months. Awareness of positive HCV vs. negative/unknown status was associated with increased recent syringe/needle sharing (aOR 2.37, 95% CI 1.15, 4.88) in multivariable analysis.

Conclusions

Risky injection behaviors remain prevalent and awareness of HCV infection was associated with increased risky injection behaviors. New approaches are needed to broadly implement HCV prevention interventions for IDUs seeking addiction treatment.

1. Introduction

Injection drug use (IDU) is the primary driver for Hepatitis C virus (HCV) transmission, accounting for the majority of chronic HCV infections in the U.S. (Alter, 1999 and Armstrong et al., 2006). Across multiple U.S. studies, 35-65% of current IDUs report risky injection behaviors such as syringe/needle sharing (Bailey et al., 2007, Booth et al., 1998, Centers for Disease Control and Prevention, 2009 and Golub et al., 2007).

Knowledge of harboring a transmissible infection such as HCV may influence risky behaviors. Prior studies of the effects of HCV-infection awareness on risky behaviors demonstrate mixed results. In a serosurvey of out-of-treatment IDUs, those who reported awareness of HCV-infection engaged in fewer risky behaviors compared with those who were unaware (Kwiatkowski, Fortuin Corsi, & Booth, 2002). HCV-aware IDUs may also "sero-sort," or preferentially engage in risky injection behaviors with others they know to be similarly HCV-infected (Burt, Thiede, & Hagan, 2009). Other studies, however, suggest that HCV awareness is insufficient to change injection risk behaviors (Norden et al., 2009). Little is known about the influence of HCV awareness on IDUs engaged in substance use treatment-information that might improve HCV prevention services in addiction treatment settings.

The purpose of this analysis was to 1) assess the prevalence and correlates of drug use practices among patients presenting for addiction treatment and 2) compare risky behaviors in those reporting HCV-infection with those who reported negative or unknown HCV status.

2. Methods

2.1. Design and setting

The primary study was a National Drug Abuse Treatment Clinical Trials Network (CTN) trial comparing the effectiveness of strategies to increase HIV testing (Metsch et al., in press). Between January and May 2009, the trial randomized 1281 individuals receiving addiction treatment at 12 geographically diverse, community-based addiction treatment programs. After providing informed consent, participants completed an audio computer assisted self interview recording substance use behaviors.

2.2. Participants

Participants receiving addiction treatment were eligible for enrollment if they were 1) ³ 18 years old, 2) reported unknown or negative HIV status, and 3) had not been tested and received results for HIV within the last 12 months. The current analysis was restricted to the 244 participants who reported IDU in the six months preceding the study baseline assessment.

2.3. Measures

Participants were asked about injection risk behaviors over the prior six months using items from Project Inspire (Purcell et al., 2004) and the NIDA Risk Behavior Assessment survey (Needle et al., 1995) including source of syringes, needle cleaning practices, how they cleaned their needles, and recent syringe/needle sharing (the main dependent variable). Participants reported injection and non-injection drug use and drinking alcohol to intoxication in the past 6 months (Colfax et al., 2004).

The independent variable was self-reported HCV infection awareness. Patients were asked, "Have you ever been diagnosed with hepatitis C (yes, no, don't know)?" Because there was no difference in syringe/needle sharing between participants who reported they were HCV-negative and those who did not know their HCV status, we dichotomized this variable as HCV-positive vs.

HCV-negative/unknown. Covariates included age, gender, race/ethnicity, employment, education, court-mandated treatment, opioid replacement treatment, and whether or not the patient had been jailed in the last 6 months.

2.4. Analysis

Descriptive statistics characterized participant socio-demographics, and substance use behaviors. We assessed bivariate and multivariable associations between participant characteristics and any syringe/needle sharing using logistic regression. Variables were included in the multivariable logistic regression model if associated with syringe/needle sharing in univariate analyses (p < .20), or on the basis of a priori hypotheses. Potential interactions were assessed.

3. Results

3.1. Participant characteristics

Of 244 recent IDUs, 60.7% were men, 66.0% white, 14.3% Hispanic, and 10.2% Black race/ethnicity, with a mean age of 39.3 (SD = 11.0) years. Twenty percent were employed, 36.2% had attained at least some college education, 30.3% had been recently incarcerated, 20.1% were receiving court-mandated treatment and 46.7% opioid replacement therapy. Ninety-two IDU (37.7%) reported being positive for HCV, 55 (22.5%) HCV-negative, and 97 (39.8%) unknown HCV status. Compared with those who were HCV negative/unaware, HCV positive IDUs were older (45.3 vs. 35.6 years, p < .001), more likely to be women (52.2% vs. 31.6%, p = .001) or enrolled in opioid replacement programs (68.5% vs. 33.6%, p < .001) and less likely to be recently incarcerated (21.7% vs. 35.5%, p = .023).

The most commonly used substances were injected opioids (71.17%), drinking alcohol to intoxication (70.9%), non-injection opioids (66.4%), marijuana (48.8%), crack cocaine (45.1%), and cocaine (30.7%). The majority of IDUs (81.1%) injected more than one substance at a time. HCV positive IDUs were less likely to drink alcohol to intoxication (57.6% vs. 78.9%, p < .001) but more likely to inject heroin (68.5% vs. 55.3%, p = .041) compared with HCV negative/unaware.

3.2. Injection risk behaviors

More than one third (38.5%) of IDUs reported syringe/needles sharing in the past 6 months (Table 1). IDUs obtained needles mostly from pharmacies, syringe exchange programs, and diabetic supplies. Less than half always used a clean needle. Among IDUs who cleaned their needles, cleaning with bleach was the most common method, but many used more ineffective sterilization methods including soap and water. More HCV-positive IDUs reported recent syringe/needle sharing compared with those with HCV negative/unknown status (44.6% vs. 38.5%, p = .131), though this was not statistically significant. There was no difference in recent syringe/needle sharing between those who reported being HCV negative vs. unknown status (36.4% vs. 34.0%, p = .771). HCV positive IDUs more frequently obtained needles from a syringe exchange program and used bleach if they cleaned needles.

In adjusted analysis (Table 2), recent syringe/needle sharing was more likely among those who reported they were HCV-positive compared with those who were HCV negative/unaware (aOR 2.37 [95% CI 1.15, 4.88]), and among IDUs obtaining needles from the street, using any opioids, marijuana, or injected crack cocaine; sharing was less likely among males and participants with some college education.

4. Discussion

Risky injection practices persist among IDUs, with rates in the current study consistent with those of other recent studies (Booth et al., 2011 and Centers for Disease Control and Prevention, 2009) and may partially explain persistently high HCV incidence among IDUs (Mehta et al., 2011). In a survey of IDUs in 23 U.S. cities from 2005 to 2006, 31.8% of IDUs reported sharing needles (Centers for Disease Control & Prevention, 2009). Among IDUs enrolling in a behavioral intervention trial (2-session HIV/HCV counseling vs. therapeutic alliance vs. treatment as usual) at residential detoxification centers from 2004 to 2006, 61% reported sharing needles, works, or drug solution (Booth et al., 2011). More widespread adoption of interventions demonstrated to reduce risky injection practices, and development of new, more effective interventions, are urgently needed for patients enrolling in community-based treatment programs.

The majority of IDUs in the present study obtained needles from safe sources, including pharmacies and syringe exchange programs, as corroborated in surveys of IDUs in other U.S. cities with policies that increase availability of sterile needles and syringes (Golub et al., 2005 and Khoshnood et al., 2000) - policies that decrease HIV transmission and likely decrease HCV transmission, as well (Des Jarlais et al., 1996 and Des Jarlais et al., 2000). Despite this, fewer than half of IDUs reported always using a clean needle or consistently cleaning needles, indicating that needle re-use and lack of needle cleaning are common. Even among the minority of IDUs reporting consistent needle cleaning, sterilization techniques other than use of bleach were frequently employed, suggesting that renewed efforts are needed to promote harm reduction techniques among IDUs. Interventions that promote needle cleaning such as peer-based (Hawkins et al., 1999 and Rietmeijer et al., 1996), pharmacy-based (Romanelli, Smith, & Pomeroy, 2000), and provider-based (Carlson, Wang, Siegal, & Falck, 1998) interventions, continue to be relevant for IDUs engaged in community-based treatment. At the same time, renewed efforts to increase availability of clean syringe/needles are urgently needed to decrease HCV transmission.

Participants who reported they were HCV positive differed in several important behaviors compared with their counterparts. HCV positive IDUs more frequently exhibited harm reduction behaviors such as obtaining needles from a syringe exchange program, cleaning needles with bleach, and avoiding drinking alcohol to intoxication, suggesting that awareness of HCV status may confer increased adoption of some protective behaviors. HCV positive IDUs, however, were also more likely to inject heroin and, in multivariable analysis, to share needles. The observed association between HCV-awareness and increased needle/syringe sharing may reflect a complex cluster of characteristics among HCV-aware IDUs in this cross-sectional study. Our data support that HCV awareness is likely a marker for IDUs with greater addiction severity (e.g., increased heroin injection and methadone maintenance among HCV-aware), addiction duration (older age among HCV-aware), and increased opportunities for HCV testing (e.g., increased needle exchange program use among HCV-aware, many of which offer HCV testing).

This finding contrasts with a sero-survey of street-recruited IDUs in Denver from 1998 to 1999, where those with a previous HCV positive test reported less receptive syringe/needle sharing, sharing of drug paraphernalia, and safer injecting practices compared with those with unknown status who tested HCV-positive during the study (Kwiatkowski et al., 2002). It is possible that in populations where higher proportions of IDUs are aware they are HCV-positive, IDUs may adopt more of a fatalistic attitude toward risky injection practices. Indeed, a recent synthesis of qualitative studies of HCV risk among IDUs identified risk ubiquity as a common theme, supporting a perception of HCV as "a risk accepted rather than avoided" (Rhodes, Singer, Bourgois, Friedman, & Strathdee, 2005). This is consistent with findings from a multicenter study of Swedish IDUs, in which 74% of those HCV-aware shared needles compared with 68% of those with unknown status (Norden et al., 2009).

The current study confirms the importance of certain demographic and drug use characteristics previously associated with syringe/needle sharing including younger age, female gender, lower educational attainment, and use of opiates, and crack cocaine. While greater addiction severity is associated with riskier injection behaviors, the current study is among the first to identify an association between marijuana use and risky injection behaviors. Marijuana use in IDUs may be a marker of risk-taking personality or chronically decreased motivation to protect oneself, as hypothesized to explain similar findings in a study of Russian IDUs (Walley et al., 2008). Further research is required to assess the nature of this association.

This study has limitations. First, our study population was recruited from individuals seeking or actively engaged in treatment in community-based treatment programs. Findings may not be generalizable to IDUs in other settings. Second, HCV status was assessed by self-report and likely underestimates the actual prevalence of HCV. However, one's belief about one's HCV status is conceptually more closely related to injection behaviors than biologically confirmed HCV status. Third, we were unable to assess sero-sorting in the current study, so increased sharing among HCV may have been with other known HCV-positive IDU, as was observed in one prior study (Burt et al., 2009). Finally, the current study's cross-sectional design limits our ability to infer causality. The observed multivariable association between knowledge of HCV status and syringe/needle sharing may reflect overall greater drug use severity among those who become HCV-infected rather than a causal pathway toward increased risky behaviors. Regardless, the association highlights the role of HCV awareness as a marker for IDUs in particular need of harm reduction interventions.

5. Conclusions

This study highlights the need for broadly implemented HCV prevention interventions for all IDUs seeking addiction treatment, and suggests such interventions might particularly decrease transmission behaviors by those aware of their HCV infection and prevent HCV infection in those HCV-negative/unaware. Research which prospectively studies the effect of HCV testing and notification on risk behavior could help further clarify the association between HCV awareness and risk behaviors. Interventions that could improve services for IDUs include those that explicitly and repeatedly educate IDUs about safer injection practices and the treatability of HCV, and those that integrate HCV testing and treatment with addiction treatment services. As HCV screening and treatment options advance, community based treatment programs have a greater opportunity to play a central role in reducing HCV transmission and engaging HCV-infected IDUs in treatment.

Role of funding source

This work was supported by the National Institute on Drug Abuse which supported the design, distribution, collection and analysis of the clinical trial. The final version of the manuscript was reviewed and approved by the NIDA Clinical Trials Network publications committee.

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Baby Boomers and the Hepatitis C Boom

Annals of Emergency Medicine
Volume 62, Issue 6 , Pages A19-A21, December 2013

Ryan L. Nave (Special Contributor to Annals News & Perspective)

Section editor: Truman J. Milling, Jr, MD

It didn't take long after rolling out a new screening program for emergency physicians at the University of Alabama at Birmingham (UAB) to realize the scope and complexity of what has been called a silent killer for baby boomers: hepatitis C.

“We had previously estimated that somewhere between 3% and 5% of persons born between 1945 and 1965, who were unaware of their hepatitis C status, would be hepatitis C antibody positive,” said James Galbraith, MD, an emergency physician at UAB.

As it turned out, the prevalence was much, much higher than anyone at UAB had expected. After screening 40 baby-boomer patients that first day, 6 results were antibody positive for hepatitis C, a blood-borne viral disease that attacks the liver but remains dormant in the body for decades before symptoms appear, typically in the form of cirrhosis, liver disease, or liver cancer.

The 76 million people born between 1945 and 1965—also known as baby boomers—are especially at risk, accounting for three quarters of all hepatitis C infections in the United States. The crisis so alarmed health officials that it prompted the US Preventive Services Task Force in 2012 to recommend that all baby boomers be screened once for the disease.

The initial higher-than-anticipated prevalence rates caused some of the emergency physicians at UAB to believe the results might be a fluke, but these continued into the next days and weeks. As of October 1, the screening program's prevalence rate of approximately 13.5% remained unchanged. In the first 2 weeks after commencing the tests, UAB tested 524 baby boomers, and 70 of those patients' results were antibody positive for hepatitis C, Dr. Galbraith said.

With numbers like that, the department is on course to screen 15,000 patients in the first year. So far, Dr. Galbraith said the department is doing fine managing the testing itself, but he's concerned about looming challenges.

“We're really trying to revise what we're doing because we were estimating somewhere between 300 and 500 [hepatitis C–positive patients] identified in the first year, and now we're talking about 1,500. The benefits to screening are lost if you're not assisting patients and getting them linked into care,” Dr. Galbraith said.

He added: “Hepatitis C is a treatable and increasingly curable disease that disproportionately affects this population. So the clock is ticking for this baby boomer generation to get them into care and possibly even curative treatment.”

The Root of the Problem 

According to Centers for Disease Control and Prevention (CDC) estimates, about 3.2 million people in the United States have chronic hepatitis C infection. Present and past injection drug users are most at risk for the infection, as are people with HIV—10% to 15% of whom are coinfected with hepatitis C—and people who received blood transfusions before 1992 when hepatitis C screening became widely available.

Infection rates for hepatitis peaked in the mid-1970s, around the time injection drug use in the United States was also at its highest levels. Around 1960, hepatitis rates increased even though hepatitis C was then known only as hepatitis non-A non-B. By the early 1990s, injection drug use and transfusion-related transmissions experienced steep declines. Since then, hepatitis C infection rates have decreased 90%, data show.

In the 2 decades since, many of those individuals who were at the greatest risk during the height of the hepatitis C infection may have stopped using injection drugs or simply forgotten about a transfusion they received during a routine surgery such as a cesarean section and do not realize they should be screened for hepatitis C.

CDC data also show that for every 100 people infected with hepatitis C, somewhere between 5 and 20 will develop cirrhosis during a 2- to 3-decade period, and between 1 and 5 will die from cirrhosis or liver cancer. One-time screening of all baby boomers could result in identifying 800,000 people with hepatitis C, the CDC said.

In August 2012, the CDC published “Recommendations for the Identification of Chronic Hepatitis C Virus Infection Among Persons Born During 1945-1965” in the agency's Morbidity and Mortality Weekly Report, which helped sound the alarm.

“Hepatitis C virus (HCV) is an increasing cause of morbidity and mortality in the United States. Many of the 2.7 [to] 3.9 million persons living with hepatitis C virus infection are unaware they are infected and do not receive care (e.g., education, counseling, and medical monitoring) and treatment. CDC estimates that although persons born during 1945 [to] 1965 comprise an estimated 27% of the population, they account for approximately three fourths of all hepatitis C virus infections in the United States, 73% of hepatitis C virus–associated mortality, and are at greatest risk for hepatocellular carcinoma and other (hepatitis C)–related liver disease,” the report states.

Additionally, the CDC said that with the advent of new therapies that can halt disease progression and provide a virologic cure in most persons, targeted testing and linkage to care for infected persons in this birth cohort is expected to reduce hepatitis C virus–related morbidity and mortality.

John W. Ward, MD, director of the CDC's Division of Viral Hepatitis, said, “A major priority for hepatitis prevention is screening to identify persons living with chronic hepatitis B and hepatitis C and linking them to care to reduce the disease and death from chronic infection.”

In 2012, Congress directed $10 million to Dr. Ward's division from the Prevention and Public Health Fund, part of the Patient Protection and Affordable Care Act, to improve testing for hepatitis B and C. More than 150 providers applied 30 funding awards for specialized screening of foreign-born populations and injection drug users and at federally qualified health centers.

Separately, UAB received funding from the CDC Foundation's Viral Hepatitis Action Coalition to screen 8,000 baby boomers for hepatitis C for 1 year. The screen itself involves a polymerase chain reaction test (patients may opt out of the screen, but that is rare) performed on blood already drawn. And even though UAB may ultimately screen more patients than physicians planned for, the paying for the tests is only one part of the equation.

“A lot of these baby boomers who ultimately need treatment for hepatitis C infection…also have other comorbid conditions that need to be treated just to make them able to tolerate the regimens for hepatitis C treatment; you know: things like diabetes, high blood pressure,” Dr. Galbraith said. “Approximately 50% of patients that we're diagnosing have publicly funded insurances like Medicaid, indigent-care insurances, or are uninsured, and that becomes a real challenge in trying to get these individuals linked into care.”

Learning From Experience 

Emergency departments are good for diagnosing problems but are not the best option for providing long-term treatment. At UAB, that's where the hospital's 1917 Clinic comes in. The clinic, which served almost 2,000 patients in 2012, is Alabama's largest HIV health care facility. A few years ago, the clinic expanded its services to include hepatitis C testing.

Ricardo Franco, MD, a member of the 1917 Clinic's staff said the hepatitis C screening program attempts to use a similar model for care as the clinic. “Many of them have the emergency room as the only source to have health care access, and not being insured, that probably favors a life trajectory of not really paying attention to health expenses,” Dr. Franco said.

Dr. Galbraith, Dr. Franco's colleague at UAB, said data suggest that hepatitis C affects men more than women and disproportionately minorities and the uninsured. Blacks have hepatitis C infection rates twice that of the general population. Information from CDC in 2012 shows that between 2000 and 2011, the rate of hepatitis C among blacks increased by 27.3%; among Hispanics, by 21.4%. Also, American Indian/Alaska natives were doubly likely to develop a case of hepatitis C compared with the white population in 2011.

Corinna Dan, RN, MPH, a viral hepatitis policy advisor with the US Department of Health and Human Services' Office of HIV/AIDS and Infectious Disease Policy, said culture could sometimes be a barrier to treatment in minority communities. “There are many challenges, including very low awareness among communities and the providers who serve them, stigma related to having hepatitis C and the behaviors that most often lead to exposure—ie, injection drug use—[and] low rates of health insurance coverage, as well as limited access to health care providers who are trained to identify individuals at risk, manage, and treat chronic hepatitis C infection. An additional challenge in the African American community is that the previously available treatment for hepatitis C was not as effective in eliminating the virus in African Americans as it was for other racial and ethnic groups. This led to people deferring screening or not following up on referral to care because there was a sense that there was no treatment for them,” Ms. Dan wrote in an e-mail.

In addition to the limited infrastructure that exists for hepatitis C screening in general, lack of public education of the disease presents an additional barrier. At the same time, though, she sees opportunities. “There is very low public awareness of this condition, but there are more materials available now than there have been in the past, including some developed specifically for minority communities. There has not historically been a large investment in hepatitis C testing by public health entities; however, with the [US Preventive Services Task Force] screening recommendation now a “B” grade, screening will be covered for individuals with health insurance as a preventive health service free of cost sharing or copay under the Affordable Care Act.” She added, “The challenge we are faced with is educating community members to request the test and health care providers to recommend the test.”

Safety Net 

Ms. Dan, of the US Department of Health and Human Services, said that a variety of strategies should be developed to increase awareness of hepatitis C and encourage people to be tested for the infection, and that EDs “can be part of the solution.”

“We are working across government to increase awareness of and appropriate screening for hepatitis C, including working with colleagues at the Health Resources and Services Administration, which supports many safety net providers, including community health centers and hospitals,” she said.

Dr. Galbraith is in agreement. “We are the safety net for our communities and, to me, if you can do some of these screenings, which are burdensome and costly, if you can find ways to cover the costs, and make these things happen in the background without disturbing the other competing priorities we have in the emergency department, then we're doing a good service not just for our individual patients but for our community.”

Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The author has stated that no such relationships exist.

The views expressed in News and Perspective are those of the authors, and do not reflect the views and opinions of the American College of Emergency Physicians or the editorial board of Annals of Emergency Medicine.

PII: S0196-0644(13)01487-X

doi:10.1016/j.annemergmed.2013.10.013

© 2013 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Source

Raising public awareness of hepatitis B and C through a testing road show

Br J Nurs. 2013 Dec 12;22(22):1308-12.

Perrett S¹, Hams P².

Abstract

Over the past decade, as the profile of hepatitis B and C has been raised, a range of nurse-led services has been developed among substance misuse services, prisons and homeless services to reach those at the highest risk of infection. In the UK, it is estimated that up to two-thirds of people with hepatitis C are unaware of their infection (Cornberg et al, 2011). These patients represent those at the highest risk of developing cirrhosis and liver cancer, and many are unlikely to be in contact with services that offer routine testing. To help address this, the Welsh Hepatitis Nurse Forum (WHNF) carried out two road shows aimed at raising awareness of hepatitis B and C among the general public and offering testing. This paper describes the process, results and evaluation of the road shows that took place in 2011 and 2012. The road show is a unique way in which nurses can reach those who may not have regular contact with health services, and has proved useful for generally raising awareness. Further work is needed to evaluate the cost-effectiveness of the road shows.

PMID: 24335868 [PubMed - in process]

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Approximately 146,500 New Yorkers are infected with hepatitis C; roughly 50 percent do not know that they are infected

FOR IMMEDIATE RELEASE
Press Release # 038-13
Monday, October 7, 2013

MEDIA CONTACT: (347) 396-4177
Jean Weinberg/Levi Fishman: Pressoffice@health.nyc.gov

Health Department Announces Plan to Combat Hepatitis C

Approximately 146,500 New Yorkers are infected with hepatitis C; roughly 50 percent do not know that they are infected

October 7, 2013 – The Health Department today released the City’s first-ever plan for reducing illness and death from the hepatitis C virus (HCV), a disease that now accounts for more annual deaths nationwide than HIV/AIDS. In Hepatitis C in New York City: State of the Epidemic and Action Plan, the Health Department calls for new efforts to expand testing for HCV and to ensure that all people with HCV infection are evaluated for treatment.

“This is a very hopeful time for persons living with hepatitis C,” Health Commissioner Dr. Thomas Farley noted today. “After many years in which the infection was very difficult to treat, hepatitis C can now be cured. We also expect that medications that are easier to use and even more effective will be available in just a few months, and many other promising drugs should be approved for use in the next few years.”

The Health Department estimates that approximately 146,500 New Yorkers are infected with HCV, which is usually transmitted when contaminated blood from one person enters another’s bloodstream. Many live in neighborhoods with high levels of poverty, unemployment, and other indices of underlying health disparities, including the South Bronx and East and Central Harlem, and only 40 percent of New Yorkers with HCV have been evaluated by a doctor for possible treatment. Most people living with HCV have few symptoms of illness until 10 to 30 years after initial infection, when life-threatening complications can develop. People with HCV are at risk for developing cirrhosis, liver cancer, and other types of liver damage. Tens of thousands of New York City residents — infected in the 1970s and 1980s — may discover that they have advanced liver disease without ever knowing that they have HCV.

The anticipated wave of HCV-related illness, leading to billions of dollars in health care costs and lost productivity, can be blunted with a concerted public health campaign that takes advantage of new tests and medications.

“Unfortunately, roughly half of those living with HCV infection do not know that they are infected,” Farley added. “With new opportunities to treat and cure this disease, all health care providers in New York City must become familiar with current recommendations for testing and treatment.”

The Health Department’s action plan identifies seven public health objectives to address the HCV epidemic in New York City, including:

1. Enhancing public awareness of HCV;
2. Enhancing health provider awareness regarding screening, diagnosis, and referral for HCV infection and clinical providers’ capacity to manage and treat HCV;
3. Enhancing linkage to care for persons with current HCV infection, identifying and promoting successful models of care, and building clinical capacity to manage and treat HCV;
4. Promoting HCV testing;
5. Enhancing HCV surveillance activities to strengthen the Health Department’s capacity to manage and utilize data for evidence-based policies and practice;
6. Promoting primary prevention; and
7. Collaborating with other organizations to develop, promote and advance policies that will support the goals of this strategy.

Hepatitis C in New York City: State of the Epidemic and Action Plan (PDF)

About Hepatitis C

Hepatitis C (HCV) is a liver disease that results from infection with the HCV virus. It can range in severity from a mild illness lasting a few weeks to a serious, lifelong illness. HCV is usually spread when blood from a person infected with HCV enters the body of someone who is not infected. Today, most people become infected with HCV by sharing needles or other equipment to inject drugs. Before 1992, when widespread screening of the blood supply began in the United States, HCV was also commonly spread through blood transfusions and organ transplants.

HCV can be either “acute” or “chronic.” Acute HCV infection is a short-term illness that occurs within the first 6 months after someone is exposed to HCV. For most, but not all, people, acute infection leads to chronic infection. When people live with chronic infection for many years, the virus can damage the liver and interfere with its important functions. Eventually, this can lead to severe liver disease, including cirrhosis and liver cancer. If people with chronic HCV infection are treated effectively before this damage occurs, the virus can be eliminated, liver function can improve, and the risk from severe liver disease and liver cancer can be greatly reduced.  

There is no vaccine for HCV. The best way to prevent HCV is by avoiding behaviors that can spread the disease, such as injection drug use.

Source

Media academy held to support prevention and treatment of hepatitis C in Middle East

United Arab Emirates: 1 hour, 21 minutes ago

As part of their ongoing commitment to reducing the growing epidemic that hepatitis C (HCV) has become in the Middle East, MSD hosted the HCV Middle East summit, which brought together more than 200 doctors from across the region to discuss the virus, the best ways to manage it and the medical breakthroughs that may help to reduce the virus's growing prevalence.

Over the course of two days, MSD brought together both international and regional medical experts to present on a range of topics, highlighting the latest clinical trials and medical advances that may help save the lives of hepatitis C sufferers.

More than 9 million people across the MENA region are already believed to be infected with hepatitis C, additionally, whilst statistics remain scarce it is estimated that as much as 13.9 people out every 100,000 UAE citizens may suffer from the virus.

On the sidelines of this conference and as part of MSD's ongoing commitment to reducing the prevalence of life threatening illnesses through continuous, MSD also hosted a media academy for more than 25 journalists from countries across the Middle East. Hosted at the Grand Hyatt in Dubai, the Academy which brought together local and regional Gastroenterologists, as well as MSD experts, covered a wide range of topics including the prevalence and causes of hepatitis C, the various treatment options available as well as those in the pipeline and the integral role the media plays in helping to reduce the hepatitis epidemic.

Talking about their decision to host both the medical conference and media academy, Dr. Ramsey Morad, Managing Director of MSD in the Middle East, said, "At MSD we are committed to providing continuous education, whether to support physicians in providing their patients with the best care possible, or whether we are working with the media, to ensure that they have the tools they need to support in raising public awareness. Hepatitis C has already become an epidemic, with WHO estimating that 3% of the world's population, or around 170 million are already infected with the virus. As a region, the Middle East and North Africa, already ranks amongst the highest in the world in terms of both prevalence and incidence. Despite the progress and medical breakthroughs that have taken place over the last decade, hepatitis C transmission rates in the MENA region, are still amongst the highest in the world. Education is crucial if we are truly to start addressing this epidemic."

Adding to Dr. Morad's comments, Mr. Mazen Altaruti, Managing Director of MSD Gulf, said, "Hepatitis C is often known as the silent killer, because in many cases there are no specific symptoms until they have advanced or become chronic hepatitis. By raising awareness and providing physicians and the general public with a better understanding of the virus and the ways to prevent it we can save the lives of the UAE citizens."

The conference and media academy are just the latest in a long line of initiatives that MSD has undertaken in the region over the last few years to try to raise awareness of hepatitis C, just some of these initiatives including free screenings and continuous education programs for physicians and medical professionals, like the Middle East School of Hepatology, that MSD launched earlier this year.

Dr. Ramsey Morad, Managing Director of MSD in the Middle East.

Source

Mural to raise awareness for Hep C

Provided by Forbes Advocate

By Sophie Harris Oct. 3, 2013, 5 a.m.

Isiaha Ramsay with the mural that he helped create with fellow classmates at Forbes High School. 0913mural(17)

A number of year nine and 10 Aboriginal students at Forbes High have been busy creating a street art mural as part of a program to raise awareness for hepatitis C.

The project, Your Mob, My Mob, Our Mob, is run by the Aboriginal Health and Medical Research Centre (AHMRC) and aims to raise awareness and increase knowledge of hepatitis C through peer education.

The project is aimed at Aboriginal adolescents aged between 12 and 19, who are taught key messages about hepatitis C in a three day workshop.

Hepatitis C Project Officer at AHMRC, Lisa Panton is in charge of running the project at Forbes High with the help of Kerry Walker, the Aboriginal Project Officer for Hepatitis at the NSW Aboriginal and Community Controlled Health Services (ACCHS).

They say the idea of the project is that on the completion of the workshop, the students will become peer educators and help to communicate information about hepatitis C to their peers.

The creation of the street art mural is part of the program and is used to continue the conversation about hepatitis.

The 11 students who participated in the program helped design and create the mural with the help of a professional graffiti artist.

Ms Walker says that involving the students in painting the mural establishes a sense of community.

“When you’ve got something like a mural that they’ve created themselves, it creates a sense of pride and having a mural that’s forever on display will continue the buzz around hepatitis,” she said.

Ms Panton says the mural is a great way to reinforce the information the students have learnt and will continue to raise awareness as a constant physical reminder.

“Everyone at the school was watching the mural go up and after we leave, they’ll still be talking about it, which is the idea,” she said.

“It keeps the conversation going,” Ms Walker adds.

The women say it’s important to talk about hepatitis to help break down the stigma and shame associated with being ill-informed about the virus.

“So we want to open up the communication channel,” Ms Walker said.

The girl who features in the mural is Nadika Vidler-McKeown, one of the Aboriginal students who participated in the workshop.

She is very happy with being chosen as the face of the mural.

“It feels awesome, I’m really proud,” she said.

“I like being able to represent my culture with things like that.”

Nadika says the students all got a lot out of the workshops and learnt some valuable information that will stick with them.

“They were really good, I learnt so much…it makes you think twice about some of the things you do,” she said.

One of the most important things the students learnt was to avoid sharing items such as toothbrushes, razors and syringes and to steer clear of getting backyard tattoos or piercings, as these can easily spread the hepatitis C virus.

This is represented in the wall mural which will be a permanent reminder to students.

At an assembly to officially present the mural to the school, principal of Forbes High, David Harris thanked the women for coming to Forbes High as part of their initiative and thanked everyone involved in the creation of the mural.

“This is fantastic and lifts up this area quite a bit,” he said.

“It’s quite worthwhile and a very big credit to you.”

Source

Inaugural African American Hepatitis C Action Day: Get Tested, Get Treated and Get the Word Out

C. Virginia Fields President & CEO, National Black Leadership Commission on AIDS

Posted: 07/25/2013 11:28 am

In a recent post, I wrote about Hepatitis C, including the statistic that black Americans are twice as likely to be infected with the Hepatitis C virus (HCV) as non-Hispanic white Americans. Baby Boomers (those born between 1945 and 1965) are five times as likely as other adults to be infected, often without knowing it. The impact of HCV on our communities is severe, and the high rate of Hepatitis C among black Americans warrants action.

The National Black Leadership Commission on AIDS, Inc. (NBLCA) is partnering with the Coalition for Positive Health Empowerment (COPE) and the Harm Reduction Coalition for the inaugural African American Hepatitis C Action Day on Thursday, July 25, to promote education, testing, and treatment to reduce the incidence of HCV in black communities across the country.

We will be holding a press conference on the steps of New York City Hall at 12 noon, and both New York State Governor Andrew Cuomo and New York City Mayor Michael Bloomberg have issued proclamations officially recognizing July 25 as African American Hepatitis C Action Day in New York.

Nearly 200,000 New York State residents are thought to be chronically infected with HCV, 60 percent of them in New York City alone. Through our partnerships with COPE, the Harm Reduction Coalition, and our regional affiliates, free testing and educational resources are being offered in Albany, Atlanta, Buffalo, New York City (including East and Central Harlem, Brooklyn, the Bronx, Queens, and Staten Island), and Rochester.

Onsite testing will be conducted at these locations using the OraQuick® HCV Rapid Antibody Test, the newest available Hepatitis C testing technology. A free, interactive webinar, "African Americans and Hepatitis C," presented by leading health experts, will provide information about clinical issues, prevention, treatment, and care.

We are establishing African American Hepatitis C Action Day not only to raise awareness locally and nationally but also as a public call to action to our communities to stand tall, stand together, get tested and, if positive, support each other in making informed decisions and healthy choices. As Eric Michael Brown, a 59-year-old black man living with HCV in Atlanta, says, "Hepatitis C doesn't have to be a death sentence. Changing your lifestyle to remain healthy and seeking proper medical treatment to sustain your health is a decision."

I believe it's not only a decision, but also a duty. Getting tested and getting treated is making a commitment to your family, friends, other loved ones, and our entire community that Hepatitis C will not destroy us. We have too much to live for and too much work to do.

For a full schedule of African American Hepatitis C Action Day events, visit www.nblca.org

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Inaugural African American Hepatitis C Action Day Promotes Education, Testing, and Treatment to Reduce High Rates of HCV in Black Communities

NEW YORK, July 24, 2013 /PRNewswire/ -- On Thursday, July 25, 2013, the National Black Leadership Commission on AIDS, Inc. (NBLCA), in partnership with the Coalition for Positive Health Empowerment (COPE) and the Harm Reduction Coalition, is spearheading the first annual African American Hepatitis C Action Day, a national community mobilization initiative aimed at reducing the high incidence of HCV infection in black communities by drawing attention to this neglected health disparity and promoting education, testing, and treatment.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that over 3.2 million adults are infected with the Hepatitis C virus (HCV)—75 percent of them "Baby Boomers"—and, because there are often no noticeable symptoms, many don't know they are infected.

For black people, the rates of HCV infection and HCV-related mortality are twice as high as they are for non-Hispanic whites. The virus, which is transmitted by blood-to-blood contact, is a leading cause of potentially fatal liver diseases such as cirrhosis and liver cancer. Early detection and intervention are essential to provide life-saving treatment and reduce the spread of the virus. 

Free testing and educational resources will be offered in all five boroughs of New York City, upstate New York (Albany, Buffalo, and Rochester), and Atlanta. Onsite testing will be conducted using the OraQuick® HCV Rapid Antibody Test, the only rapid HCV test approved by the FDA.

"HCV is a silent killer in the U.S. today, and the rate of infection is disproportionately high in black communities," said C. Virginia Fields, President and CEO of NBLCA. "We organized this day of action to educate our communities about this serious health risk, provide them with access to free screenings and resources that will help preserve their health and well-being, and publicly highlight the need for continued vigilance to stem the tide of this epidemic."

New York State and City proclamations recognizing July 25 as African American Hepatitis C Action Day will be presented at a press conference led by C. Virginia Fields on the steps of New York City Hall at 12 noon. Nearly 200,000 NY State residents are thought to be chronically infected with HCV, 60% of them in New York City.  Last month, the New York State Senate and Assembly approved legislation that would require hospitals and health care practitioners to offer Hepatitis C screenings to all people born between 1945 and 1965—the Baby Boomer generation, which has the highest rate of HCV infection. The bill has not yet been signed by Governor Cuomo.

For a full schedule of African American Hepatitis C Action Day events, visit www.nblca.org.

The mission of the National Black Leadership Commission on AIDS, Inc. (NBLCA) is to educate, mobilize, and empower black leaders to meet the challenge of fighting HIV/AIDS and other health disparities in their local communities.

Media Contacts:
Teri Wade, 212-595-4047, teri@missionandmessage.com
Jacqueline Lara, 240-305-2133, jlara@mpactpr.com

SOURCE National Black Leadership Commission on AIDS, Inc.

RELATED LINKS
http://www.nblca.org

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Half a Diagnosis: Gap in Confirming Infection among Hepatitis C Antibody-positive Patients

The American Journal of Medicine

Article in Press

Emily McGibbon, MPH, Katherine Bornschlegel, MPH, Sharon Balter, MD

New York City Department of Health and Mental Hygiene, Long Island City, NY

published online 19 June 2013.
Corrected Proof

Abstract

Background

Recent guidelines recommend testing all individuals born during 1945-1965 for hepatitis C virus (HCV) antibody. For antibody-positive patients, subsequent RNA testing is necessary to determine current infection status. This study aimed to assess whether clinicians order HCV RNA tests as recommended for antibody-positive patients and to identify barriers to such testing.

Methods

We sampled individuals newly reported to the New York City Department of Health and Mental Hygiene's HCV surveillance system and collected information from clinicians. For patients without RNA test results, we asked the reason an RNA test was not ordered and requested that the clinician order the test.

Results

Of 245 antibody-positive patients, 67% were tested for HCV RNA (for 21% of these, the test was ordered only after our request); 33% had no RNA testing despite our request. Patients without RNA testing were seen in medical facilities (47%), detox facilities (30%), and jail/prison (15%). Reasons RNA testing was not done were that the patient did not return for follow-up (35%), the facility does not do RNA testing (22%), and the patient was tested in jail (15%).

Conclusions

In our study, one third of patients did not get complete testing for accurate diagnosis of HCV, which is essential for medical management. Additional education for clinicians about the importance of RNA testing may help. However, with improved antiviral treatments now available for HCV, it is time for reflex HCV RNA testing for positive antibody tests to become routine, just as reflex Western blot testing is standard for human immunodeficiency virus.

Keywords: Hepatitis C, Surveillance, Testing

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Red Door Communications - World Hepatitis Day 2012

Promotional Feature

prweek.com, Thursday, 27 June 2013, 1:56pm

500 million people globally live with either chronic hepatitis B or C.  Whilst that’s higher than the prevalence of HIV or any cancer, the disease is hugely underfunded, with thousands remaining undiagnosed. On a personal level, the disease is too often ignored and shrouded in stigma.

World Hepatitis Day (WHD) takes place on July 28th and is one of four days recognised by the World Health Organisation, aiming to raise awareness of the disease amongst a global community.

The World Hepatitis Alliance wanted a campaign that could be taken up by 100 local groups, was scalable to their needs, and meaningful in all contexts.

By raising awareness among the public the Alliance wanted to prevent new infections and deliver real improvements in health outcomes for people with hepatitis B and C.

The Alliance also wanted to widen access to treatment and lessen the stigma around viral hepatitis by highlighting the prevalence and indiscriminate nature of the disease. Above all the campaign needed to inspire action: know it, confront it, and get tested.

Any potential pitfalls you needed to take into account?

The previous year’s campaign ‘Am I number 12?’ successfully engaged 81 groups around the world, but there was potential to engage more groups to ensure unified action.

In addition, with an average of 3,402 visitors per month to the Alliance website during the previous year’s campaign, the challenge was also set to engage with more audiences online than ever before and look at ways to target audiences in developing countries such as Africa, where viral hepatitis is extremely prevalent and access to the internet is limited.

OK and what was your grand plan to tackle this?

Red Door Communications developed a campaign that sought pro-active engagement and directly communicated the stark reality of hepatitis; with the strap-line - `it’s closer than you think’.

Ten hard-hitting posters were developed communicating the impact of the disease and practical toolkits to implement a local campaign. All were developed in seven languages and distributed to the Alliance’s 193 member countries.

Community engagement was key - so we designed a Guinness World Record attempt for ‘the most number of individuals performing the gestures of "See No Evil, Hear No Evil, Speak No Evil" in a 24 hour period’. These actions were based on the proverb known as the three wise monkeys who cover their eyes, ears and mouth to avoid uncomfortable truths.

This created a striking visual of the denial in which hepatitis is shrouded. To achieve the record, 25 people at ten different locations needed to perform the actions. The event was supported by a Twitter campaign and Facebook app.

A pilot SMS campaign to drive people to get tested was developed with mobile network providers in Ghana, Kenya and South Africa.

Sounds good - What outcome did all this have on your client’s business?

107 patient groups participated in the campaign compared to 81 from the previous year. Traffic to the Alliance website increased by 14.6% compared with 10% in the same period in 2011.

The Twitter campaign asked people to tweet photos of themselves performing the ‘three wise monkeys’ poses.  These were posted to #seehearspeakno and automatically uploaded into an online gallery linked to the World Hepatitis Alliance website, Twitter feed and Facebook page.

Automatic replies were sent to each tweet to thank users and to let them know about their nearest Guinness World Record venue to drive attendance. 1.7 million tweets were posted and measured through the hashtag. 12,588 people participated in the Guiness World Record in 42 locations around the world.

The SMS text-blasting campaign reached 1.45 million people and a staggering 24.5% of people in South Africa texted back to receive more information.

Impressive - Any gems of wisdom you learned from working on this that you’d like to pass on?

Twitter was a great way to engage people with the live Guinness World Record attempt and even received spontaneous celebrity endorsement from famous names such as Sadie Frost, Boy George, and Fat Boy Slim who posted photos to help raise the profile of the campaign.

Building an auto-tweet system was a very effective way of communicating essential public health information. Every time a tweet included a mention of the hashtag, a response was sent back to the user to thank them for getting involved and to provide additional information about the wider World Hepatitis Day campaign.

Establishing partnerships with Mobile Network Operators in Ghana, Kenya and South Africa allowed dissemination of important SMS messages to millions of people in areas where a greater health need exists.

Source

NY Baby Boomers Could Avoid Serious Disease With New Hep C Test Requirement

June 20, 2013

Bill Passed by Legislature Requires Offer of Screening Test for Boomers Visiting Doctor or Hospital; Follows Recommendation by Centers for Disease Control

(ALBANY, N. Y.)Baby boomers across New York, many of whom may have hepatitis C without knowing it, will be offered a screening test when visiting health care providers under an AARP-backed bill passed by the state Legislature today.

The bill (S2750A/A1286), sponsored by Senate Health Committee Chairman Kemp Hannon (R-Nassau) and Assemblyman Kenneth Zebrowski (D-New City), requires people born between 1945 and 1965 to be offered a screening test for hepatitis C – a potentially fatal illness - when seeing their primary care doctor and receiving hospital inpatient and outpatient care.

The federal Centers for Disease Control and Prevention (CDC) called for such testing last August after finding people born between 1945 and 1965 are at risk for Hepatitis C infection. Those baby boomers accounted for 75 percent of the estimated 3.2 million Americans infected with hepatitis C, the CDC found.

An estimated 200,000 New Yorkers are living with Hepatitis C, and it’s an increasing cause of illness and death. But 45 percent to 85 percent of people living with the disease are unaware they have it, since it often shows no symptoms, according to a CDC report.

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver and can lead to cirrhosis (scarring of the liver) or fatal liver cancer.

“This is truly a life and death matter, and AARP is so pleased that Senator Hannon and Assemblyman Zebrowski won such an important victory for baby boomers,” said Beth Finkel, AARP New York State Director. “Offering a screening test to the thousands of New Yorkers whose lives could be saved or improved is just plain common sense.”

The bill passed the Senate today 63-0. It passed the Assembly 138-1 on June 10.

There have been great advances over the past few years in treatments for hepatitis C and many carrying the disease can be cured.

By increasing testing opportunities, the bill will make more people living with hepatitis C aware of their infection status, get available treatment, and take steps to prevent transmission.

Empowering individuals to know their hepatitis C infection status is an important step toward meeting the public health challenges presented by a disease which is contagious and communicable. Given that many people infected with this disease show no symptoms, testing is a crucial factor in disease prevention.

New York City Mayor Michael Bloomberg’s health commissioner, Dr. Thomas Farley, urged colleagues this spring to test all baby boomers for hepatitis C.

AARP New York, which advocates on behalf of New Yorkers 50 and older, is calling on Governor Andrew Cuomo to sign the bill into law.

Follow us on Twitter: @AARPNY and Facebook: AARP New York

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families such as healthcare, employment and income security, retirement planning, affordable utilities and protection from financial abuse. We advocate for individuals in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services. A trusted source for lifestyle tips, news and educational information, AARP produces AARP The Magazine, the world’s largest circulation magazine; AARP Bulletin; www.aarp.org; AARP TV & Radio; AARP Books; and AARP en Español, a Spanish-language website addressing the interests and needs of Hispanics. AARP does not endorse candidates for public office or make contributions to political campaigns or candidates. AARP Foundation is an affiliated charity of AARP that is working to win back opportunity for struggling Americans 50+ by being a force for change on the most serious issues they face today: housing, hunger, income and isolation. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.

Source

Also See:

• Bill would provide Hep-C testing for more NY'ers
• NBLCA Supports Proposed New York State Legislation That Would Expand Testing for Hepatitis C Virus in Baby Boomers

The silent pandemic: Tackling hepatitis C with policy innovation

Report by the Economist Intelligence Unit supported by Janssen

Governments across the world will have to face up to the challenges posed by the hepatitis C (HCV) pandemic or experience spiralling healthcare costs, says the Economist Intelligence Unit in its report The silent pandemic: Tackling hepatitis C with policy innovation.

The report, made possible as a result of an educational grant from Janssen, challenges countries to use co-ordinated strategies to tackle HCV but warns that this will not be easy because few countries understand the magnitude of the disease. The report finds that in the European Union, only the Netherlands has the kind of epidemiological data robust enough to inform policy.

What the report highlights is that because levels of awareness are so low, many people only receive an HCV diagnosis when diagnosed with its end-stage conditions such as cirrhosis or liver cancer. Poor healthcare practices, such as failing to screen donated blood and the use of unsterilised medical equipment, are the cause of millions of cases in the developing world.

The report concludes that countries need to improve the data they have in order to introduce a comprehensive approach to tackling HCV. This will include raising awareness about the disease, taking preventative measures, especially within health services, and making a real effort to reach vulnerable patient groups with available treatments treatments before end-stage conditions develop.

Download report

Download Info-graphic

See what the experts say about the report

Watch Infomercial

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Hep C test bill clears Assembly

Vocal New York, a grassroots advocacy group representing low income residents, and Assemblyman Kenneth Zebrowski, are pushing for the passage of Hepatitis-C testing legislation in the Senate, with only a few days left in session. Photo by Cassandra Hamdan.

By RICHARD MOODY

June 17, 2013

People in black and white tee-shirts with Vocal New York printed across their fronts crowded the Million Dollar Staircase in the Capitol; signs, that said, "Hep C Testing = Saved Lives," and "Fight Hep C," waved in the air; chants of, "No justice, no peace," and "End Hep-C" reverberated up and down the staircase; Tuesday was a day to make history in the eyes of some 50 people.

"You are all making history here," Assemblyman Kenneth Zebrowski, D-New City, told the group of advocates from Vocal New York, a grassroots advocacy group that speaks on the behalf of low-income people, and concerned individuals as they rallied behind a bill (A.1286/S.2750) — the first piece of legislation of its kind nationally — to add a new section to the public health law requiring certain health service providers to offer Hepatitis-C tests to people born between 1945 and 1965. The baby boomer generation has the highest prevalence of Hepatitis-C of any other generation, with 1 out of 30 having Hepatitis-C, according to the Centers for Disease Control and Prevention. Zebrowski said that, though the CDC is not 100 percent sure why baby boomers are so much more susceptible, he believes it's because blood was not typically tested before widespread transfusions began in the early 1990s

Under the bill, if the test should come out positive, the insurance provider must offer follow-up health care or refer the infected individual to a provider who can, including a Hepatitis-C diagnostic test.

The bill would also require the state health commissioner to evaluate the impact of the legislation and report the findings to the governor and the Legislature.

The bill passed in the Assembly on June 10 and advanced into its third reading in the Senate on the same day. The bill was sponsored in the Assembly by Zebrowski whose father, also an assemblyman, died in 2007 of Hepatitis-C. "Three to five million people have Hep-C and most of them don't even know," Zebrowski said. He seemed optimistic about the possibility of the bill passing in the Senate, saying that all it needs is a "little push."

"We will get this all signed into law."

Assemblywoman Joan Millman, D-Brooklyn, who co-sponsors the bill, said her message was simple, "We need to pass this bill."

The rally was emceed by Bobby Tolbert, a board member of Vocal New York, who opened the floor to personal testimonies. One such testimony was given by a Diane Nunez who was diagnosed with Hepatitis-C in 1998 and went for treatment in 2003. "This is a pandemic in our communities," said Nunez, "We have to end Hep-C."

Hadiyah Charles, a longtime HIV/AIDS prevention advocate associated with the Lower East Side Harm Reduction Coalition, praised state lawmakers for taking a big step in national history and said that with this legislation "New York should cause a domino effect" of other states passing similar legislation.

Sammy Santiago, who was tested in 1996 for Hepatitis-C and was declared "undetectable," earlier this year found out he had cirrhosis of the liver. He has been getting treatment for Hepatitis-C for four months. "In the first four weeks I was declared undetectable again," Santiago said. Santiago stressed the importance of getting tested for Hepatitis-C, "That's what's important; we all need to be educated."

Assemblyman Zebrowski said he remains optimistic that the Senate will pass the bill.

George Santana of the CitiWide Harm Reduction Coalition spoke about his experience after being diagnosed with Hepatitis-C. "I've done the treatment. It sucks, anyone who has done it knows what I'm saying, but it was worth it," Santana said. "We must continue to fight, because I know deep in my heart this bill will pass."

Source

Calls to help support local filmmaker raising awareness

Calls to help support local filmmaker raising awareness

SamanthaJ33169 12th Jun 2013 3:16 PM

Young local filmmaker, Lee Philipson, is currently making a name for himself in local and regional film festivals, having recently graduated from a Bachelor of Media through Southern Cross University. Despite a shortage of opportunities on a regional scale, Lee has been frivolously shooting and entering competitions as a pathway to the industry.

He recently entered a short film competition where entrants were asked to shoot a public service announcement raising awareness for Hepatitis-C, to de-stigmatise the illness. With a bounty of entries from all around the nation, Lee's short film "Hep C: See the person behind the illness" was selected by a panel of judges for the top six finalists. Now, Lee is busily promoting the film online to gain the many public votes, crucial to win the competition.

"It's amazing the amount of support you can get in a very short amount of time on social media sites like Facebook," the budding director claims, "but we're still looking to broaden the reach of our message".

Lee wants to encourage Coffs Harbour locals to rally behind him in support of regional film talent, to help get the word out that Coffs Harbour is fully committed to it's vibrant film community.

"It's not just about winning," says the filmmaker, "It's also really important that our film is able to reach out to people and let them know that Hepatitis C doesn't have to be a life sentence."
Lee encourages locals to head to the See The Real Thing competition website and vote for the film.

www.seetherealthing.com.au
Head to the video gallery page and look for "Hep C- See the person behind the illness" By Lee Philipson.

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Bill would provide Hep-C testing for more NY'ers

Photo by Cassandra Hamdan.

By RICHARD MOODY

June 11, 2013

A group of about 50 advocates dressed in black and white T-shirts with "Vocal New York" printed across their fronts crowded the Million Dollar Staircase in the Capitol; signs, that said, "Hep C Testing = Saved Lives," and "Fight Hep C," waved in the air; chants of, "No justice, no peace," and "End Hep-C" reverberated up and down the staircase.

"You are all making history here," Assemblyman Zebrowski said to the group of advocates from Vocal New York, a grassroots advocacy group that speaks on the behalf of low-income people, and concerned individuals as they rallied behind a bill (A.1286/S.2750) — the first piece of legislation of its kind nationally — to add a new section to the public health law requiring certain health service providers to offer Hepatitis-C tests to people born between 1945 and 1965. And if the test should come out positive the provider must offer follow-up health care ¬— or refer the infected individual to a provider who can — including a Hepatitis-C diagnostic test.

The bill also requires the state health commissioner to evaluate the impact of the legislation and report the findings to the governor and Legislature.

The bill passed in the Assembly on Monday and advanced into its third reading in the Senate on the same day. The bill was sponsored in the Assembly by Assemblyman Kenneth Zebrowski, D-New City, whose father, also an assemblyman, died in 2007 of Hepatitis-C. "Three to five million people have Hep-C and most of them don't even know," Zebrowski said. He seemed optimistic about the possibility of the bill passing in the Senate saying that all it needs is a "little push."

"We will get this all signed into law."

Assemblywoman Joan Millman, D-Brooklyn, who co-sponsored the bill, said her message was simple, "We need to pass this bill."

The rally was emceed by Bobby Tolbert, a board member of Vocal New York, who tried to buy time for Sen. Kemp Hannon, R-Garden City, sponsor of the bill in the Senate, to arrive to the press event by opening the floor to personal testimonies. One such testimony was given by a Diane Nunez who was diagnosed with Hepatitis-C in 1998 and went for treatment in 2003. "This is a pandemic in our communities," said Nunez, "We have to end Hep-C."

Hadiyah Charles, a longtime advocate HIV/AIDES prevention associated with the Lower East Side Harm Reduction Coalition, praised New York for taking a big step in national history and said that with this legislation "New York should cause a domino effect" of other states passing similar legislation.

Sammy Santiago, a concerned individual who was tested in 1996 for Hepatitis-C and was declared "undetectable" and earlier this year found out he had cirrhosis of the liver, has been getting treatment for Hepatitis-C for four months. "In the first four weeks I was declared undetectable again," Santiago said. Santiago stressed the importance of getting tested for Hepatitis-C, "That's what's important: we all need to be educated."

George Santana of the CitiWide Harm Reduction Coalition spoke about his experience after being diagnosed with Hepatitis-C. "I've done the treatment. It sucks, anyone who has done it knows what I'm saying, but it was worth it," Santana said. "We must continue to fight, because I know deep in my heart this bill will pass."

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Also See: NBLCA Supports Proposed New York State Legislation That Would Expand Testing for Hepatitis C Virus in Baby Boomers

Hepatitis C 101: Protecting High-Risk Baby Boomers and Vulnerable Communities From the Silent Epidemic

Huffington Post

C. Virginia Fields President & CEO, National Black Leadership Commission on AIDS

Posted: 06/10/2013 2:36 pm

I talk and write a lot about the disproportionate impact of HIV/AIDS and other health disparities on communities of color and other vulnerable populations. During Hepatitis C Awareness Month this past May, the National Black Leadership Commission on AIDS, Inc. (NBLCA) joined with other groups and organizations to educate and inform our communities about this often-invisible virus that has become a silent epidemic in the United States.

Left untreated, the Hepatitis C virus (HCV) causes potentially life-threatening liver damage. African Americans are twice as likely to be infected with HCV than non-Hispanic whites and are also twice as likely to have chronic (lifelong) rather than acute (non-recurring) Hepatitis C. Four times as many African Americans and Latinos have Hepatitis C than have HIV.

At highest risk for HCV infection are baby boomers -- people born between 1945 and 1964. According to the U.S. Centers for Disease Control and Prevention (CDC), more than 75 percent of the 3.2 million adults with HCV in the U.S. are baby boomers. Most don't even know they are infected, and without treatment, their risk of developing serious and even fatal liver diseases, such as cirrhosis and liver cancer, greatly increases.

On the June 5 premiere of Health Action Radio, the weekly, hour-long radio series presented by NBLCA on WWRL1600 AM in New York City, I moderated a discussion about Hepatitis C with Gloria Searson, president and founder of the Coalition on Positive Health Empowerment (COPE), and Hadiyah Charles, Hepatitis C Advocacy Manager at the Harm Reduction Coalition.

According to Ms. Searson, the majority of available information indicates that the lifestyles lived by many people in the 1970s, many of them baby boomers, exposed them in large numbers to the blood-borne Hepatitis C virus. (Many people were also infected during medical procedures before 1992, when the U.S. introduced universal blood product screening.) In fact, Ms. Searson indicated that many baby boomers have been living unknowingly with the virus for as long as 30 years. This is so because there are often no telltale signs of infection. She said baby boomers should be tested and screened not only for HCV but also for all seven types of hepatitis that exist.

Ms. Searson also noted that the co-infection rates for Hepatitis C and other diseases in communities of color are high. African Americans often fall through the cracks of the health care system because many access medical care only through emergency room visits. And, because instances of Hepatitis C are now based mostly on self-reporting, detection is difficult.

There are currently two ways to get tested: Ask for a blood test from your physician or go to an organization such as COPE for a rapid finger stick test, and within 20 minutes you will receive the results. If you don't have the virus, you will receive counseling and information that will help you prevent future infection. If you do test positive, you will be referred to appropriate and affordable care and treatment.

HCV is an epidemic and silent killer in the U.S. today, and we must be proactive about measures that will prevent its spread and help those at risk gain access to treatment. NBLCA fully supports New York State legislation A1286/S2750, which would require health care providers and hospitals to offer those born between 1945 and 1964, with their consent, screening for the Hepatitis C virus (HCV).

As Ms. Charles of the Harm Reduction Coalition pointed out, this legislation, if passed, may be a first-in-the-nation law that could be the "first domino" to fall that will prompt other states with a high HCV prevalence to follow suit.

Policy prompts action and influences budgets. It is imperative to get this legislation passed and signed into law. Since our legislators are working on behalf of us, their constituents, we want them to know that we support this ground-breaking, farsighted proposed legislation.

Please take action and call your state senator to encourage him or her to support A1286/S2750. There is information on the Harm Reduction Coalition's website to assist you in contacting your representatives. You can also help us show our state legislators that we have mobilized broad support for the measure by attending a rally in Albany on Tuesday, June 11.

Advocates, academics, medical professionals, legislators, policy experts, citizens, non-profit organizations, faith-based institutions, and others must work together to highlight and remedy the dire health consequences of Hepatitis C in our communities. We must have, as President Barack Obama has said so many times, all hands on deck.

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