Hepatitis C information: Treatment strategies and guidance virus treatment strategies
The Health Care Authority is partnering with the Department of Health to share a series of messages with health care providers about best practices in prevention and treatment of hepatitis C. This is the first of several messages we will share over the next six months.
The goals of this first message are to: provide best practice recommendations about caring for priority populations, bring attention to the role stigma plays in limiting access to care, and raise health disparity awareness.
Recommended best practices for addressing hepatitis C in Washington
Health care providers play a critical role in ensuring people who are living with hepatitis C or who are at risk of infection get the care and guidance they need. These are recommended activities for clinicians and care teams to put into practice:
- Screen all persons born 1945-1965 at least once in their lifetime.
- Screen all persons with risk factors for hepatitis C, all persons living with HIV and anyone originating from the former Soviet Union or Syria at their first medical visit.
- Screen all persons currently using injection drugs annually.
- Screen former injection drug users, including those who injected only once many years ago.
- Follow up with antibody-positive patients in your practice to ensure they receive a confirmatory RNA test and are linked to care for treatment.
- Implement systems to promote screening and referral for care.
- Integrate hepatitis C treatment into your clinical practice.
- Counsel hepatitis-C positive persons on adherence for those receiving treatment, transmission prevention, and liver health.
- Counsel hepatitis C-negative persons who may be at high risk about prevention strategies, such as safer drug use practices, linkages to care, treatment, and recovery services.
Clinical guidance for diagnosis and treatment
Oral direct-acting antiviral (DAA) medications, with unprecedented effectiveness and tolerability, are now the standard curative treatments hepatitis C. Due to changes in diagnosis and treatment technologies, the guidance changes often, so we suggest reviewing this resource regularly.
The American Association for the Study of Liver Disease and the Infectious Diseases Society of America have developed guidance that represents the best clinical practices for hepatitis prevention, testing, and management. Their guidance is available at https://www.hcvguidelines.org.
The Health Care Authority’s policy for hepatitis C for Washington Apple Health (Medicaid) provides detailed direction on approval protocols, preferred DAA products, provider requirements for treatment and care management, and medical necessity determination protocols.
Hepatitis C treatment coverage and financial support
DAA medication and clinical monitoring are covered by major commercial insurance plans, Medicare and Apple Health (Medicaid). Manufacturers offer additional support through patient assistance programs. Initiating treatment can take time and require a lot of paperwork. Consider partnering with a specialty pharmacy to help relieve the administrative burden. A specialty pharmacy specializes in medication management for complex conditions and managing specialty drugs with expertise in serving patients with hepatitis C and other chronic disease.
Resources and training opportunities for clinicians
The University of Washington (UW) hosts an educational website for health care providers.
- The hepatitis C continuing education courses are free and include educational resources related to diagnosis, monitoring, and management. Continuing Medical Education (CME) and Continuing Nursing Education (CNE) credits are available. More information is available athttps://www.hepatitisc.uw.edu/.
- UW’s Project ECHO HCV mentors clinicians in underserved/rural areas in the treatment of hepatitis C. Project ECHO provides primary care clinicians with access to: UW Medicine specialists in infectious disease, hepatology, and addiction medicine; brief updates on evidence-based strategies to treat HCV; CME credits per hour of participation. More information is available at https://www.uwmedicine.org/referrals/telehealth-services/provider. (Please note that Project ECHO may currently be at capacity, so check with them for availability.)
Stigma and health disparities considerations
In recent years, diagnoses of hepatitis C have increased among people under the age of 40, largely associated with the opioid crisis and increases in people injecting drugs and sharing equipment. Active injection drug use is not a contraindication to hepatitis C therapy. Treating and curing hepatitis C among people who inject drugs is critical not only for their health, but for curbing ongoing transmission of the virus. Consider partnering with a syringe services program and substance use treatment service provider in your area for additional support. Program and contact information for syringe service programs is available athttps://www.doh.wa.gov/Portals/1/Documents/5620/150-096-SyringeProgramsWA.pdf. Program and contact information for substance use treatment services is available at https://www.dshs.wa.gov/bha/substance-use-treatment-services.
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