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Sponsored
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Her work can also be heard on NPR, \u003cem>Here & Now, \u003c/em>and PRI. Before working in audio, she taught, leading groups of students abroad. One of her favorite jobs was teaching on the Thai-Burmese border, working with immigrants and refugees.\r\n\r\nLaura has won three Northern California Area Emmys along with her Deep Look colleagues. She's won the North Gate Award for Excellence in Audio Reporting and the Gobind Behari Lal Award for a radio documentary about adults with imaginary friends. She's a fellowship junkie, completing the USC Center for Health Journalism's California Fellowship, UC Berkeley's Human Rights Fellowship and the Coro Fellowship in Public Affairs. Laura has a master’s in journalism from UC Berkeley and a master’s in education from Harvard.\r\n\r\nShe likes to eat chocolate for breakfast. She's also open to eating it all day long.","avatar":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twitter":"lauraklivans","facebook":null,"instagram":null,"linkedin":null,"sites":[{"site":"news","roles":["editor"]},{"site":"stateofhealth","roles":["contributor","editor"]},{"site":"science","roles":["editor"]},{"site":"forum","roles":["editor"]}],"headData":{"title":"Laura Klivans | KQED","description":"Reporter and Host","ogImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g","twImgSrc":"https://secure.gravatar.com/avatar/af8e757bb8ce7b7fee6160ba66e37327?s=600&d=blank&r=g"},"isLoading":false,"link":"/author/lklivans"}},"breakingNewsReducer":{},"campaignFinanceReducer":{},"firebase":{"requesting":{},"requested":{},"timestamps":{},"data":{},"ordered":{},"auth":{"isLoaded":false,"isEmpty":true},"authError":null,"profile":{"isLoaded":false,"isEmpty":true},"listeners":{"byId":{},"allIds":[]},"isInitializing":false,"errors":[]},"navBarReducer":{"navBarId":"home","fullView":true,"showPlayer":false},"navMenuReducer":{"menus":[{"key":"menu1","items":[{"name":"News","link":"/","type":"title"},{"name":"Politics","link":"/politics"},{"name":"Science","link":"/science"},{"name":"Education","link":"/educationnews"},{"name":"Housing","link":"/housing"},{"name":"Immigration","link":"/immigration"},{"name":"Criminal Justice","link":"/criminaljustice"},{"name":"Silicon Valley","link":"/siliconvalley"},{"name":"Forum","link":"/forum"},{"name":"The California Report","link":"/californiareport"}]},{"key":"menu2","items":[{"name":"Arts & Culture","link":"/arts","type":"title"},{"name":"Critics’ Picks","link":"/thedolist"},{"name":"Cultural Commentary","link":"/artscommentary"},{"name":"Food & Drink","link":"/food"},{"name":"Bay Area Hip-Hop","link":"/bayareahiphop"},{"name":"Rebel Girls","link":"/rebelgirls"},{"name":"Arts Video","link":"/artsvideos"}]},{"key":"menu3","items":[{"name":"Podcasts","link":"/podcasts","type":"title"},{"name":"Bay Curious","link":"/podcasts/baycurious"},{"name":"Rightnowish","link":"/podcasts/rightnowish"},{"name":"The Bay","link":"/podcasts/thebay"},{"name":"On Our Watch","link":"/podcasts/onourwatch"},{"name":"Mindshift","link":"/podcasts/mindshift"},{"name":"Consider This","link":"/podcasts/considerthis"},{"name":"Political Breakdown","link":"/podcasts/politicalbreakdown"}]},{"key":"menu4","items":[{"name":"Live Radio","link":"/radio","type":"title"},{"name":"TV","link":"/tv","type":"title"},{"name":"Events","link":"/events","type":"title"},{"name":"For Educators","link":"/education","type":"title"},{"name":"Support KQED","link":"/support","type":"title"},{"name":"About","link":"/about","type":"title"},{"name":"Help Center","link":"https://kqed-helpcenter.kqed.org/s","type":"title"}]}]},"pagesReducer":{},"postsReducer":{"stream_live":{"type":"live","id":"stream_live","audioUrl":"https://streams.kqed.org/kqedradio","title":"Live Stream","excerpt":"Live Stream information currently unavailable.","link":"/radio","featImg":"","label":{"name":"KQED Live","link":"/"}},"stream_kqedNewscast":{"type":"posts","id":"stream_kqedNewscast","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/newscast.mp3?_=1","title":"KQED Newscast","featImg":"","label":{"name":"88.5 FM","link":"/"}},"stateofhealth_362025":{"type":"posts","id":"stateofhealth_362025","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"362025","score":null,"sort":[1512046824000]},"guestAuthors":[],"slug":"theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it","title":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?","publishDate":1512046824,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>\u003cspan style=\"font-weight: 400\">A small purple-and-white sign hangs on the waiting room wall in Highland Hospital’s emergency department in Oakland.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In English and Spanish it reads: \"Our ER’s policy for patients 18 to 75 years old: HIV and Hepatitis C tests are done once a year if you are having other blood tests.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s a policy that emergency room physician Doug White and his colleagues instituted four years ago. Since up to half of people with hepatitis C do not know they are infected, testing is the first step toward eradicating the deadly, blood-borne virus, he said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C is the leading cause of liver failure in the U.S.,\" White said. \"It's the number one cause of liver cancer. Number one cause of liver transplants. It’s a phenomenon of epic proportion.\"\u003c/span>\u003c/p>\n\u003cp>[audio src=\"https://www.kqed.org/.stream/anon/radio/tcr/2017/11/KlivansHepCCure.mp3\" Image=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28161_IMG_7054-qut-1180x885.jpg\" Title=\"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?\" program=\"The California Report\"]\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">B\u003c/span>\u003cspan style=\"font-weight: 400\">etween 2.7 million and 3.9 million Americans have hepatitis C\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, according to the Centers for Disease Control and Prevention (CDC). The virus can remain dormant for years, and by the time symptoms arise, the organs may already be damaged. Except for flu, \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/hcv-mortality.html\" target=\"_blank\" rel=\"noopener\">hepatitis C \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">takes more lives than all other CDC-tracked infectious diseases \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">combined -- and that includes HIV, tuberculosis and other more prominent diseases.\u003c/span>\u003c/i> \u003cspan style=\"font-weight: 400\">In 2015,\u003c/span>\u003ca href=\"https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">19,629 Americans died\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from hepatitis C, mostly from liver disease caused by the virus. \u003c/span>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For years the few treatments for hepatitis C had severe side effects and were not very effective at eliminating the virus from the body. But a new generation of powerful drugs came out in late 2013. These drugs have minimal side effects and usually require taking just one pill a day for two to three months. The cure rate is more than 90 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Given this powerful new option, it’s possible to\u003c/span>\u003ca href=\"http://nationalacademies.org/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">eliminate hepatitis C as a public health threat in the U.S. by 2030\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers say. But social and financial barriers remain, so it would take a concerted effort by government, health plans, doctors and hospitals.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. White hopes Highland Hospital can be a leader in the fight, and a model for other hospitals tackling the hepatitis C epidemic. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C has gone from a disease that I had no incentive to look for to diagnose, because I couldn't do anything about it, to essentially a curable disease with treatment that's well tolerated,\" White said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Highland staffers test nearly everyone who comes to the ER and gets blood drawn. They've built a robust electronic medical system that reminds medical staff to test for hepatitis C when doing other blood tests, as long as the patient hasn't had this test in the past year. Highland was one of the first ERs to test for hepatitis C like this nationwide. That helps flag infections among low-income or undocumented patients who use the ER for primary care. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362079\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362079\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg\" alt=\"Dr. Doug White points to tubes used for Hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Doug White points to tubes used for hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the work doesn't end in the ER. If patients test positive, they get a call or visit from Mae Petti.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Petti has a desk a few floors above the emergency room. She spends hours making phone call after phone call. In her friendly, polite but insistent manner, she persists until she speaks with every patient on her list. As Highland's hepatitis C linkage coordinator, Petti will contact patients again and again until they come in to get follow-up care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Few hospitals have someone like Petti -- her position at Highland is grant-funded. And her work is paying off: Highland has doubled the number of people who return for follow-up appointments. Now, patients can start getting treated for hepatitis C in as soon as two weeks. Previously, it took six months after a positive test before a patient began treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>San Francisco's Mission to Stamp out the Virus\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Across the bay, San Francisco has its own approach to the problem. A group there has been addressing hepatitis C since former Mayor Gavin Newsom assigned a specific \u003c/span>\u003ca href=\"http://sfhepc.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">task force\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the issue in 2009. The group’s mission was first to recommend how the city should address hepatitis C. These days, they believe the threat of hepatitis C can be stamped out, and they think San Francisco is the place to do it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At a recent task force gathering at San Francisco’s Department of Public Health, doctors, public health workers and many former hepatitis C patients -- now cured -- took their seats around a table.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a dinner of pizza and salad, San Francisco’s viral hepatitis coordinator, Katie Burk, launched into a presentation. She listed reasons why she thinks San Francisco is a great candidate for elimination. First, she said, the city of San Francisco is small.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That matters when you’re trying to grab folks from all parts of the city, and make sure they’re getting the care they need,\" Burk said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And there’s a historical commitment to fighting disease here.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We have this really incredible HIV program infrastructure in San Francisco,\" she said. \"We've built a lot of what we've done with hepatitis C sort of on the back of that program, and learned from a lot of our successes and challenges.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hepatitis C is transmitted by blood -- and these days most of that happens through shared needles. Stopping the spread of the virus is therefore inextricably connected with efforts to end addiction to injectable drugs. San Francisco has places to exchange dirty syringes for clean ones, and plenty of programs and clinics offer “medication-assisted treatment” -- usually using buprenorphine, which helps people addicted to heroin and other opioids kick the habit. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco has another weapon too: a coalition specifically devoted to hepatitis C elimination, called \u003c/span>\u003ca href=\"http://www.endhepcsf.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">End Hep C SF\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It launched in 2016. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The End Hep C SF coalition has created something that experts consider crucial for the elimination of hepatitis C: an accurate estimate of how many residents harbor the virus, whether they are aware of it or not. In San Francisco, the current estimate is 12,000 people. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s unusual for a city to have a number like that to work with, because typically public health departments know only the number of people who have recently tested positive for hepatitis C. But San Francisco officials have gone farther: subtracting estimates of people who have been cured, died or moved away. They have calculated how many people probably have the virus, but have yet to be diagnosed.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Having that estimate is exciting, according to public health consultant Shelley Facente, who was also at the meeting, because it will allow the city to set goals of how many people to treat each year, and can offer an idea of when hepatitis C can largely be wiped out. The data have also helped identify target groups that have disproportionately high rates of hepatitis C in San Francisco, like transgender women. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facente said roughly 4,500 San Franciscans already have been cured, using the new class of treatments for hepatitis C. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That means this is doable,\" Facente said, referring to elimination. \"We can really make this happen. It's very exciting that we've already made such progress. And now that we have even more information about what we need to do and where we need to go, it's even going to get better from here.\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Remaining Barriers to Elimination\u003c/strong>\u003c/p>\n\u003cp>Back at Highland Hospital, patient June Bullock had an appointment to pick up a refill of pills for his hepatitis C treatment. He met with physician assistant Amy Smith, who guides Highland patients through the treatment. Smith handed Bullock his last pack of pills and asked if he had any questions. His wife, Alfreda, was the one who spoke up.\u003c/p>\n\u003cfigure id=\"attachment_362085\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362085\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg\" alt=\"June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"My daughter says nobody can drink behind him out of a straw,\" Alfreda Bullock said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"No,\" Smith replied. \"That’s not true.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There’s a whole bunch of stuff going on, you know what I’m saying?\" Bullock said, explaining she’d heard a lot of misinformation about the virus.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Smith took the blame. \"Yeah. Well, I’m sorry we haven’t covered that.\" Smith then reviewed for them how hepatitis C is spread.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Research shows that to really curb hepatitis C, it takes a program like Highland’s: test widely, and then treat aggressively.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But, new hepatitis C infections still increased in California by 5.5 percent between 2011 and 2015, according to the state Department of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s frustrating for people like Smith, who has seen many people get cured.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There are a lot of good people out there doing good work,\" she said. \"I just don’t think all the pieces are in place just yet.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Unaffordable drugs, for instance, are still one of the biggest barriers to treatment, Smith said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The cheapest available drug retails at about $26,000 for a course that ranges from two to four months. Others can cost as much as $133,400. While insurance companies often negotiate lower prices, some have still tried to control costs by instituting limits on who qualifies for treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Another problem is the nationwide opioid epidemic, which includes heroin abuse, often via needle. Many experts say that’s why hepatitis C infections are rising among people under 30 -- although hepatitis C has traditionally been considered a disease of the baby boomers. This older generation grew up before the virus was identified, let alone subject to screening in the blood supply. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some advocates say the fight against hepatitis C is especially difficult because society places little value on the lives of the people who tend to get the virus -- current or former drug users, jail inmates and former prisoners.\u003c/span>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Despite the challenges, efforts in the Bay Area show progress is still possible. The hope is that if a city like San Francisco can eliminate hepatitis C, others will follow suit. \u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"Oakland's Highland Hospital and a coalition in San Francisco are moving the needle on hepatitis C elimination.","status":"publish","parent":0,"modified":1512088784,"stats":{"hasAudio":true,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":44,"wordCount":1775},"headData":{"title":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It? | KQED","description":"Oakland's Highland Hospital and a coalition in San Francisco are moving the needle on hepatitis C elimination.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?","datePublished":"2017-11-30T13:00:24.000Z","dateModified":"2017-12-01T00:39:44.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"362025 https://ww2.kqed.org/stateofhealth/?p=362025","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/11/30/theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it/","disqusTitle":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?","path":"/stateofhealth/362025/theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan style=\"font-weight: 400\">A small purple-and-white sign hangs on the waiting room wall in Highland Hospital’s emergency department in Oakland.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">In English and Spanish it reads: \"Our ER’s policy for patients 18 to 75 years old: HIV and Hepatitis C tests are done once a year if you are having other blood tests.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s a policy that emergency room physician Doug White and his colleagues instituted four years ago. Since up to half of people with hepatitis C do not know they are infected, testing is the first step toward eradicating the deadly, blood-borne virus, he said. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C is the leading cause of liver failure in the U.S.,\" White said. \"It's the number one cause of liver cancer. Number one cause of liver transplants. It’s a phenomenon of epic proportion.\"\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"audio","attributes":{"named":{"src":"https://www.kqed.org/.stream/anon/radio/tcr/2017/11/KlivansHepCCure.mp3","image":"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28161_IMG_7054-qut-1180x885.jpg","title":"There's a Cure for Hepatitis C. Why Are So Many People Still Dying from It?","program":"The California Report","label":""},"numeric":[]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ca href=\"https://www.cdc.gov/hepatitis/hcv/cfaq.htm\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">B\u003c/span>\u003cspan style=\"font-weight: 400\">etween 2.7 million and 3.9 million Americans have hepatitis C\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, according to the Centers for Disease Control and Prevention (CDC). The virus can remain dormant for years, and by the time symptoms arise, the organs may already be damaged. Except for flu, \u003ca href=\"https://www.cdc.gov/nchhstp/newsroom/2016/hcv-mortality.html\" target=\"_blank\" rel=\"noopener\">hepatitis C \u003c/a>\u003c/span>\u003cspan style=\"font-weight: 400\">takes more lives than all other CDC-tracked infectious diseases \u003c/span>\u003ci>\u003cspan style=\"font-weight: 400\">combined -- and that includes HIV, tuberculosis and other more prominent diseases.\u003c/span>\u003c/i> \u003cspan style=\"font-weight: 400\">In 2015,\u003c/span>\u003ca href=\"https://www.cdc.gov/hepatitis/statistics/2015surveillance/commentary.htm\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">19,629 Americans died\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> from hepatitis C, mostly from liver disease caused by the virus. \u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">For years the few treatments for hepatitis C had severe side effects and were not very effective at eliminating the virus from the body. But a new generation of powerful drugs came out in late 2013. These drugs have minimal side effects and usually require taking just one pill a day for two to three months. The cure rate is more than 90 percent. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Given this powerful new option, it’s possible to\u003c/span>\u003ca href=\"http://nationalacademies.org/hmd/Reports/2016/Eliminating-the-Public-Health-Problem-of-Hepatitis-B-and-C-in-the-US.aspx\" target=\"_blank\" rel=\"noopener\"> \u003cspan style=\"font-weight: 400\">eliminate hepatitis C as a public health threat in the U.S. by 2030\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">, researchers say. But social and financial barriers remain, so it would take a concerted effort by government, health plans, doctors and hospitals.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Dr. White hopes Highland Hospital can be a leader in the fight, and a model for other hospitals tackling the hepatitis C epidemic. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"Hepatitis C has gone from a disease that I had no incentive to look for to diagnose, because I couldn't do anything about it, to essentially a curable disease with treatment that's well tolerated,\" White said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Highland staffers test nearly everyone who comes to the ER and gets blood drawn. They've built a robust electronic medical system that reminds medical staff to test for hepatitis C when doing other blood tests, as long as the patient hasn't had this test in the past year. Highland was one of the first ERs to test for hepatitis C like this nationwide. That helps flag infections among low-income or undocumented patients who use the ER for primary care. \u003c/span>\u003c/p>\n\u003cfigure id=\"attachment_362079\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362079\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg\" alt=\"Dr. Doug White points to tubes used for Hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28164_IMG_7065-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Dr. Doug White points to tubes used for hepatitis C blood tests. Highland Hospital's emergency room has routinized their system so nearly every patient already getting blood drawn will also be tested for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">And the work doesn't end in the ER. If patients test positive, they get a call or visit from Mae Petti.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Petti has a desk a few floors above the emergency room. She spends hours making phone call after phone call. In her friendly, polite but insistent manner, she persists until she speaks with every patient on her list. As Highland's hepatitis C linkage coordinator, Petti will contact patients again and again until they come in to get follow-up care. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Few hospitals have someone like Petti -- her position at Highland is grant-funded. And her work is paying off: Highland has doubled the number of people who return for follow-up appointments. Now, patients can start getting treated for hepatitis C in as soon as two weeks. Previously, it took six months after a positive test before a patient began treatment.\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>San Francisco's Mission to Stamp out the Virus\u003c/strong>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Across the bay, San Francisco has its own approach to the problem. A group there has been addressing hepatitis C since former Mayor Gavin Newsom assigned a specific \u003c/span>\u003ca href=\"http://sfhepc.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">task force\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\"> to the issue in 2009. The group’s mission was first to recommend how the city should address hepatitis C. These days, they believe the threat of hepatitis C can be stamped out, and they think San Francisco is the place to do it. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">At a recent task force gathering at San Francisco’s Department of Public Health, doctors, public health workers and many former hepatitis C patients -- now cured -- took their seats around a table.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">After a dinner of pizza and salad, San Francisco’s viral hepatitis coordinator, Katie Burk, launched into a presentation. She listed reasons why she thinks San Francisco is a great candidate for elimination. First, she said, the city of San Francisco is small.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That matters when you’re trying to grab folks from all parts of the city, and make sure they’re getting the care they need,\" Burk said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">And there’s a historical commitment to fighting disease here.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"We have this really incredible HIV program infrastructure in San Francisco,\" she said. \"We've built a lot of what we've done with hepatitis C sort of on the back of that program, and learned from a lot of our successes and challenges.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Hepatitis C is transmitted by blood -- and these days most of that happens through shared needles. Stopping the spread of the virus is therefore inextricably connected with efforts to end addiction to injectable drugs. San Francisco has places to exchange dirty syringes for clean ones, and plenty of programs and clinics offer “medication-assisted treatment” -- usually using buprenorphine, which helps people addicted to heroin and other opioids kick the habit. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">San Francisco has another weapon too: a coalition specifically devoted to hepatitis C elimination, called \u003c/span>\u003ca href=\"http://www.endhepcsf.org/\" target=\"_blank\" rel=\"noopener\">\u003cspan style=\"font-weight: 400\">End Hep C SF\u003c/span>\u003c/a>\u003cspan style=\"font-weight: 400\">. It launched in 2016. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The End Hep C SF coalition has created something that experts consider crucial for the elimination of hepatitis C: an accurate estimate of how many residents harbor the virus, whether they are aware of it or not. In San Francisco, the current estimate is 12,000 people. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">It’s unusual for a city to have a number like that to work with, because typically public health departments know only the number of people who have recently tested positive for hepatitis C. But San Francisco officials have gone farther: subtracting estimates of people who have been cured, died or moved away. They have calculated how many people probably have the virus, but have yet to be diagnosed.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Having that estimate is exciting, according to public health consultant Shelley Facente, who was also at the meeting, because it will allow the city to set goals of how many people to treat each year, and can offer an idea of when hepatitis C can largely be wiped out. The data have also helped identify target groups that have disproportionately high rates of hepatitis C in San Francisco, like transgender women. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Facente said roughly 4,500 San Franciscans already have been cured, using the new class of treatments for hepatitis C. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"That means this is doable,\" Facente said, referring to elimination. \"We can really make this happen. It's very exciting that we've already made such progress. And now that we have even more information about what we need to do and where we need to go, it's even going to get better from here.\"\u003c/span>\u003c/p>\n\u003cp>\u003cstrong>Remaining Barriers to Elimination\u003c/strong>\u003c/p>\n\u003cp>Back at Highland Hospital, patient June Bullock had an appointment to pick up a refill of pills for his hepatitis C treatment. He met with physician assistant Amy Smith, who guides Highland patients through the treatment. Smith handed Bullock his last pack of pills and asked if he had any questions. His wife, Alfreda, was the one who spoke up.\u003c/p>\n\u003cfigure id=\"attachment_362085\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-362085\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg\" alt=\"June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/11/RS28167_IMG_7070-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">June (left) and Alfreda Bullock at Highland Hospital to pick up June's final pack of medication for hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"My daughter says nobody can drink behind him out of a straw,\" Alfreda Bullock said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"No,\" Smith replied. \"That’s not true.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There’s a whole bunch of stuff going on, you know what I’m saying?\" Bullock said, explaining she’d heard a lot of misinformation about the virus.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Smith took the blame. \"Yeah. Well, I’m sorry we haven’t covered that.\" Smith then reviewed for them how hepatitis C is spread.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Research shows that to really curb hepatitis C, it takes a program like Highland’s: test widely, and then treat aggressively.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">But, new hepatitis C infections still increased in California by 5.5 percent between 2011 and 2015, according to the state Department of Public Health.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">That’s frustrating for people like Smith, who has seen many people get cured.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">\"There are a lot of good people out there doing good work,\" she said. \"I just don’t think all the pieces are in place just yet.\"\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Unaffordable drugs, for instance, are still one of the biggest barriers to treatment, Smith said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">The cheapest available drug retails at about $26,000 for a course that ranges from two to four months. Others can cost as much as $133,400. While insurance companies often negotiate lower prices, some have still tried to control costs by instituting limits on who qualifies for treatment. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Another problem is the nationwide opioid epidemic, which includes heroin abuse, often via needle. Many experts say that’s why hepatitis C infections are rising among people under 30 -- although hepatitis C has traditionally been considered a disease of the baby boomers. This older generation grew up before the virus was identified, let alone subject to screening in the blood supply. \u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Some advocates say the fight against hepatitis C is especially difficult because society places little value on the lives of the people who tend to get the virus -- current or former drug users, jail inmates and former prisoners.\u003c/span>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: 400\">Despite the challenges, efforts in the Bay Area show progress is still possible. The hope is that if a city like San Francisco can eliminate hepatitis C, others will follow suit. \u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/362025/theres-a-cure-for-hepatitis-c-why-are-so-many-people-still-dying-from-it","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2746","stateofhealth_13","stateofhealth_1"],"tags":["stateofhealth_3204","stateofhealth_2808","stateofhealth_2867","stateofhealth_3205","stateofhealth_2519"],"featImg":"stateofhealth_362054","label":"stateofhealth"},"stateofhealth_361327":{"type":"posts","id":"stateofhealth_361327","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361327","score":null,"sort":[1507145585000]},"guestAuthors":[],"slug":"hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment","title":"Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment","publishDate":1507145585,"format":"standard","headTitle":"Kaiser Health News | State of Health | KQED News","labelTerm":{"term":3007,"site":"stateofhealth"},"content":"\u003cp>Valerie Green is still waiting to be cured.\u003c/p>\n\u003cp>The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn’t qualify yet for the Medicaid program’s criteria for treatment with a new class of highly effective but pricey drugs. The recent approval of a less expensive drug that generally cures hepatitis C in just eight weeks may make it easier for more insurers and correctional facilities to expand treatment.\u003c/p>\n\u003cp>The drug, \u003ca href=\"https://www.mavyret.com\" target=\"_blank\" rel=\"noopener\">Mavyret\u003c/a>, is the first to be \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm570038.htm\" target=\"_blank\" rel=\"noopener\">approved by the Food and Drug Administration\u003c/a> that can cure all six genetic types of hepatitis C in about two months in patients who haven’t previously been treated. Other approved drugs generally require 12 weeks to treat the disease and often aren’t effective for all types of hepatitis C.\u003c/p>\n\u003cp>In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about \u003ca href=\"https://www.macpac.gov/wp-content/uploads/2017/03/High-Cost-HCV-Drugs-in-Medicaid-Final-Report.pdf\" target=\"_blank\" rel=\"noopener\">$55,000 to $95,000\u003c/a> to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.\u003c/p>\n\u003cp>“It certainly stands to reason that the continual march downwards on cost would lead to continual opening up of criteria,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hepatitis C is a viral liver infection spread through blood that affects an estimated 3.5 million people in the United States. It can take years to cause problems. Many baby boomers who contracted it decades ago before blood was screened for the virus don’t realize they have it until they develop liver disease. In addition, the growing heroin epidemic is adding to the problem as people become infected by sharing contaminated needles.\u003c/p>\n\u003cp>“Direct acting antiviral” therapies like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks, are much more effective than earlier treatments that required weekly interferon injections and multiple daily pills for nearly a year. But the newer regimens came at a price: $94,500, in Harvoni’s case.\u003c/p>\n\u003cp>State Medicaid programs, which cover a high proportion of people with hepatitis C, \u003ca href=\"http://www.governing.com/news/headlines/how-some-state-medicaid-programs-limit-drugs-to-only-sickest-patients.html\" target=\"_blank\" rel=\"noopener\">balked at the high prices\u003c/a>, even with the 23 percent drug discount the programs typically receive. Many threw up roadblocks to limit drug approval until the disease was advanced. Some required people to be drug- and alcohol-free for six months or more before treatment would be approved.\u003c/p>\n\u003cp>Those moves prompted advocates to push for better access, in some cases \u003ca href=\"https://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/\" target=\"_blank\" rel=\"noopener\">filing suit\u003c/a> to force the programs to cover more people.\u003c/p>\n\u003cp>Faced with a lawsuit in Delaware, the state Medicaid program began loosening up treatment criteria this year, and in January will \u003ca href=\"https://www.chlpi.org//wp-content/uploads/2016/06/DMMA-Prior-Authorization-Policy.pdf\" target=\"_blank\" rel=\"noopener\">begin approving enrollees\u003c/a> regardless of the severity of their disease.\u003c/p>\n\u003cp>The state joins more than a dozen others that no longer (or never did) restrict hepatitis C treatment based on disease severity, said Kevin Costello, director of litigation at Harvard Law School’s Center for Health Law and Policy Innovation, which has been a key player \u003ca href=\"https://www.chlpi.org/in-face-of-class-action-lawsuit-delaware-medicaid-removes-unlawful-restrictions-to-the-cure-for-the-hepatitis-c-virus/\" target=\"_blank\" rel=\"noopener\">in litigation in Delaware\u003c/a> and other states.\u003c/p>\n\u003cp>It can’t happen soon enough, said Green, 58, who believes she contracted the disease 31 years ago when she suffered complications during childbirth and required a blood transfusion. Although her liver isn’t damaged, Green said, she’s suffered with abdominal and joint pain, weight loss and fatigue for decades, symptoms that doctors attribute to the hepatitis C virus.\u003c/p>\n\u003cp>“It’s been a difficult fight for us Medicaid patients,” she said.\u003c/p>\n\u003cp>People who are incarcerated \u003ca href=\"http://content.healthaffairs.org/content/35/10/1893.abstract\" target=\"_blank\" rel=\"noopener\">face an even tougher battle\u003c/a> to get treatment for hepatitis C. Roughly 17 percent of prisoners are infected with hepatitis C, compared with about 1 percent of the general population.\u003c/p>\n\u003cp>Prisons have a duty not to be deliberately indifferent to the medical needs of incarcerated people. Prisons don’t get the price discounts that the Medicaid programs have, and their budgets are fixed.\u003c/p>\n\u003cp>“Administrators have to make do with what is there,” said Dr. Anne Spaulding, an associate professor at Emory University’s public health school who has worked as a medical director in corrections and published research on hepatitis C among prisoners.\u003c/p>\n\u003cp>Lawyers in a handful of states are pursuing class action lawsuits to force prisons to provide hepatitis C treatment. Mavyret may make a difference, said David Rudovsky, a civil rights lawyer who’s litigating a class action lawsuit against the Pennsylvania Department of Corrections.\u003c/p>\n\u003cp>“Everyone recognizes that it’s going to make it easier to cover people,” he said.\u003c/p>\n\u003cp>People with regular private insurance may face some obstacles to coverage of hepatitis C, but coverage is typically less problematic. For example, Mavyret is one of seven hepatitis C drugs that are included in the 2018 \u003ca href=\"http://lab.express-scripts.com/lab/insights/drug-options/2018-national-preferred-formulary\" target=\"_blank\" rel=\"noopener\">national preferred formulary\u003c/a> by Express Scripts, which manages the pharmacy benefits for 83 million people.\u003c/p>\n\u003cp>“The benefit to patients and payers is the additional competition, which brings down costs across the class, thus resulting in greater access and affordability,” said Jennifer Luddy, director of corporate communications at Express Scripts.\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"http://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN). KHN is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"The drug, sold under the name Mavyret, can cure all six genetic types of the liver disease in eight weeks at a cost of $26,400, well below other options.","status":"publish","parent":0,"modified":1507146691,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":24,"wordCount":933},"headData":{"title":"Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment | KQED","description":"The drug, sold under the name Mavyret, can cure all six genetic types of the liver disease in eight weeks at a cost of $26,400, well below other options.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment","datePublished":"2017-10-04T19:33:05.000Z","dateModified":"2017-10-04T19:51:31.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"361327 https://ww2.kqed.org/stateofhealth/?p=361327","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/10/04/hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment/","disqusTitle":"Hepatitis C Drug’s Lower Cost Paves Way For Medicaid, Prisons To Expand Treatment","nprByline":"\u003ca href=\"https://californiahealthline.org/news/author/michelle-andrews/\">\u003cstrong>Michelle Andrews\u003c/strong>\u003c/a>","path":"/stateofhealth/361327/hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Valerie Green is still waiting to be cured.\u003c/p>\n\u003cp>The Delaware resident was diagnosed with hepatitis C more than two years ago, but she doesn’t qualify yet for the Medicaid program’s criteria for treatment with a new class of highly effective but pricey drugs. The recent approval of a less expensive drug that generally cures hepatitis C in just eight weeks may make it easier for more insurers and correctional facilities to expand treatment.\u003c/p>\n\u003cp>The drug, \u003ca href=\"https://www.mavyret.com\" target=\"_blank\" rel=\"noopener\">Mavyret\u003c/a>, is the first to be \u003ca href=\"https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm570038.htm\" target=\"_blank\" rel=\"noopener\">approved by the Food and Drug Administration\u003c/a> that can cure all six genetic types of hepatitis C in about two months in patients who haven’t previously been treated. Other approved drugs generally require 12 weeks to treat the disease and often aren’t effective for all types of hepatitis C.\u003c/p>\n\u003cp>In addition, Mavyret’s price tag of $26,400 for a course of treatment is significantly below that of other hepatitis C drugs whose sticker price ranges from about \u003ca href=\"https://www.macpac.gov/wp-content/uploads/2017/03/High-Cost-HCV-Drugs-in-Medicaid-Final-Report.pdf\" target=\"_blank\" rel=\"noopener\">$55,000 to $95,000\u003c/a> to beat the disease. Patients and insurers often pay less, however, through negotiated insurance discounts and rebates.\u003c/p>\n\u003cp>“It certainly stands to reason that the continual march downwards on cost would lead to continual opening up of criteria,” said Matt Salo, executive director of the National Association of Medicaid Directors.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hepatitis C is a viral liver infection spread through blood that affects an estimated 3.5 million people in the United States. It can take years to cause problems. Many baby boomers who contracted it decades ago before blood was screened for the virus don’t realize they have it until they develop liver disease. In addition, the growing heroin epidemic is adding to the problem as people become infected by sharing contaminated needles.\u003c/p>\n\u003cp>“Direct acting antiviral” therapies like Harvoni, a once-a-day pill introduced in 2014 that generally cured hepatitis C in 12 weeks, are much more effective than earlier treatments that required weekly interferon injections and multiple daily pills for nearly a year. But the newer regimens came at a price: $94,500, in Harvoni’s case.\u003c/p>\n\u003cp>State Medicaid programs, which cover a high proportion of people with hepatitis C, \u003ca href=\"http://www.governing.com/news/headlines/how-some-state-medicaid-programs-limit-drugs-to-only-sickest-patients.html\" target=\"_blank\" rel=\"noopener\">balked at the high prices\u003c/a>, even with the 23 percent drug discount the programs typically receive. Many threw up roadblocks to limit drug approval until the disease was advanced. Some required people to be drug- and alcohol-free for six months or more before treatment would be approved.\u003c/p>\n\u003cp>Those moves prompted advocates to push for better access, in some cases \u003ca href=\"https://khn.org/news/medicaid-private-insurers-begin-to-lift-curbs-on-pricey-hepatitis-c-drugs/\" target=\"_blank\" rel=\"noopener\">filing suit\u003c/a> to force the programs to cover more people.\u003c/p>\n\u003cp>Faced with a lawsuit in Delaware, the state Medicaid program began loosening up treatment criteria this year, and in January will \u003ca href=\"https://www.chlpi.org//wp-content/uploads/2016/06/DMMA-Prior-Authorization-Policy.pdf\" target=\"_blank\" rel=\"noopener\">begin approving enrollees\u003c/a> regardless of the severity of their disease.\u003c/p>\n\u003cp>The state joins more than a dozen others that no longer (or never did) restrict hepatitis C treatment based on disease severity, said Kevin Costello, director of litigation at Harvard Law School’s Center for Health Law and Policy Innovation, which has been a key player \u003ca href=\"https://www.chlpi.org/in-face-of-class-action-lawsuit-delaware-medicaid-removes-unlawful-restrictions-to-the-cure-for-the-hepatitis-c-virus/\" target=\"_blank\" rel=\"noopener\">in litigation in Delaware\u003c/a> and other states.\u003c/p>\n\u003cp>It can’t happen soon enough, said Green, 58, who believes she contracted the disease 31 years ago when she suffered complications during childbirth and required a blood transfusion. Although her liver isn’t damaged, Green said, she’s suffered with abdominal and joint pain, weight loss and fatigue for decades, symptoms that doctors attribute to the hepatitis C virus.\u003c/p>\n\u003cp>“It’s been a difficult fight for us Medicaid patients,” she said.\u003c/p>\n\u003cp>People who are incarcerated \u003ca href=\"http://content.healthaffairs.org/content/35/10/1893.abstract\" target=\"_blank\" rel=\"noopener\">face an even tougher battle\u003c/a> to get treatment for hepatitis C. Roughly 17 percent of prisoners are infected with hepatitis C, compared with about 1 percent of the general population.\u003c/p>\n\u003cp>Prisons have a duty not to be deliberately indifferent to the medical needs of incarcerated people. Prisons don’t get the price discounts that the Medicaid programs have, and their budgets are fixed.\u003c/p>\n\u003cp>“Administrators have to make do with what is there,” said Dr. Anne Spaulding, an associate professor at Emory University’s public health school who has worked as a medical director in corrections and published research on hepatitis C among prisoners.\u003c/p>\n\u003cp>Lawyers in a handful of states are pursuing class action lawsuits to force prisons to provide hepatitis C treatment. Mavyret may make a difference, said David Rudovsky, a civil rights lawyer who’s litigating a class action lawsuit against the Pennsylvania Department of Corrections.\u003c/p>\n\u003cp>“Everyone recognizes that it’s going to make it easier to cover people,” he said.\u003c/p>\n\u003cp>People with regular private insurance may face some obstacles to coverage of hepatitis C, but coverage is typically less problematic. For example, Mavyret is one of seven hepatitis C drugs that are included in the 2018 \u003ca href=\"http://lab.express-scripts.com/lab/insights/drug-options/2018-national-preferred-formulary\" target=\"_blank\" rel=\"noopener\">national preferred formulary\u003c/a> by Express Scripts, which manages the pharmacy benefits for 83 million people.\u003c/p>\n\u003cp>“The benefit to patients and payers is the additional competition, which brings down costs across the class, thus resulting in greater access and affordability,” said Jennifer Luddy, director of corporate communications at Express Scripts.\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"http://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This story was produced by \u003c/em>\u003cem>\u003ca href=\"http://www.kaiserhealthnews.org/\" target=\"_blank\" rel=\"noopener\">Kaiser Health News\u003c/a> (KHN). KHN is a national health policy news service. It is an editorially independent program of the \u003ca href=\"http://www.kff.org/\" target=\"_blank\" rel=\"noopener\">Henry J. Kaiser Family Foundation\u003c/a>.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361327/hepatitis-c-drugs-lower-cost-paves-way-for-medicaid-prisons-to-expand-treatment","authors":["byline_stateofhealth_361327"],"categories":["stateofhealth_2442","stateofhealth_13"],"tags":["stateofhealth_2808","stateofhealth_2867","stateofhealth_3172","stateofhealth_218","stateofhealth_2519"],"affiliates":["stateofhealth_3007"],"featImg":"stateofhealth_361331","label":"stateofhealth_3007"},"stateofhealth_361087":{"type":"posts","id":"stateofhealth_361087","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"361087","score":null,"sort":[1506031075000]},"guestAuthors":[],"slug":"in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead","title":"In the Battle Against Hepatitis C, the VA Takes the Lead","publishDate":1506031075,"format":"audio","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Junius Wilson likes to dress up when he goes in for his appointments at the \u003ca href=\"https://www.va.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Veterans Affairs\u003c/a> in Martinez. On a recent visit, the 67-year-old wore a black felt fedora and a sport coat. On his lapels, he wore a handful of military medals.\u003c/p>\n\u003cp>\"All these are medals from Vietnam,\" he said. \"The three stars are for warriors ... this one's national defense.\"\u003c/p>\n\u003cp>Wilson's wife, Shelly Baker, sat beside him. She nudged him to show off one medal, which hung from a violet ribbon: a Purple Heart.\u003c/p>\n\u003cp>Wilson got that one because he was shot in the foot diving for cover during battle. He was in the infantry in South Vietnam and saw a lot of combat.\u003c/p>\n\u003cp>But Wilson, 67, isn't here for that. He's come for a monthly consultation with a specialized VA nurse who oversees his hepatitis C treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers.\u003c/p>\n\u003cp>While about 1 percent of the U.S. population is infected with hepatitis C, veterans who use the VA have higher rates, 4.8 percent.\u003c/p>\n\u003cp>And Vietnam-era veterans like Wilson have an even higher rate, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24682941\" target=\"_blank\" rel=\"noopener noreferrer\">studies\u003c/a>, VA data and physicians. Not all Vietnam veterans use the VA for health care, but among those who do, 7.5 percent have tested positive for the virus.\u003c/p>\n\u003cp>It's unclear why, but there are several theories. One is simply the demographic overlap between Vietnam veterans and baby boomers. Members of the baby-boom generation have Hepatitis C infection rates five times higher than the average American. Hepatitis C, which is blood-borne, wasn't even identified as a distinct virus until 1989, and the baby boomers grew up in an era when blood wasn’t screened, and \u003ca href=\"http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30002-0/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">before disposable needles were common in medical settings\u003c/a>.\u003c/p>\n\u003cp>Some attribute the higher rate of Hepatitis C in Vietnam veterans to the injections they received before deploying: Troops sent to Vietnam were often vaccinated assembly-line style, with something called a jet injector. Instead of a needle, a jet injector uses high pressure to force a vaccine through the skin. Later, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11427278\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> showed that older versions of the device could \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00000744.htm\" target=\"_blank\" rel=\"noopener noreferrer\">transmit\u003c/a> a hepatitis virus from person to person, and it's no longer used in the military. While it is impossible to know if jet injectors spread the hep C virus, the VA has said it is \"\u003ca href=\"https://www.hepatitis.va.gov/provider/policy/military-blood-exposures.asp\" target=\"_blank\" rel=\"noopener noreferrer\">biologically plausible\u003c/a>.\"\u003c/p>\n\u003cp>Others point out that some veterans of this conflict used intravenous drugs while in Vietnam, or after returning to the U.S.\u003c/p>\n\u003cp>Hepatitis C is passed through the blood. About 3.5 million Americans have the virus, and it's believed that half of them do not know it. After the discovery of the virus in 1989, screening of the blood supply didn't begin until 1992.\u003c/p>\n\u003cp>The virus can lurk silently for years, slowly damaging the liver until symptoms appear, like pain, nausea and yellow skin. It kills \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html\" target=\"_blank\" rel=\"noopener noreferrer\">more Americans\u003c/a> than all other infectious diseases combined, including HIV. In 2014, the death toll reached an all-time high of 19,659.\u003c/p>\n\u003cfigure id=\"attachment_361111\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-361111 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg\" alt=\"VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The VA's push to find -- and cure -- every patient with the virus began three years ago.\u003c/p>\n\u003cp>This became feasible only when new hepatitis C medications came to market in late 2013. The new generation of drugs was a huge improvement over previous treatments. The older drugs required shots that were injected into the stomach, and the medications could have severe side effects: flulike symptoms and even mental health problems.\u003c/p>\n\u003cp>VA nurse Susan Bertilacchi-Green does not miss those days. A decade ago, the cure rate she observed from those older drugs was about 30 percent, she said.\u003c/p>\n\u003cp>\"That was then,\" she said. \"Now, we have new medications that are nearly 100 percent effective. They have little to no side effects. You can be treated in as little as eight weeks, and there's no shots anymore.\"\u003c/p>\n\u003cp>Since 2014, the VA has cured 96,000 patients of hepatitis C.\u003c/p>\n\u003cp>Vietnam veteran Roman Walden is one of them. He thinks he got the virus while injecting heroin in Vietnam, a habit that continued when he returned home to Oakland. Years ago, he tried treatment on the old drugs, but had to stop due to serious side effects. When the new drugs came out, he was hesitant to try treatment again. But with reassurance from Bertilacchi-Green, and other veterans who'd been cured, he yielded. This time, the treatment worked.\u003c/p>\n\u003cfigure id=\"attachment_361112\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361112\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg\" alt=\"Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of Hepatitis C. \" width=\"800\" height=\"613\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-768x588.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1020x781.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1180x904.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-960x735.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-240x184.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718.jpg 1560w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I was really amazed at that,\" he said. \"But then what really got me was how much it cost, and that made me feel like the president of the United States. They were spending this much money on me?\"\u003c/p>\n\u003cp>Hepatitis C drugs have become notorious for their high cost. The wholesale price for a course of treatment can be over $100,000.\u003c/p>\n\u003cp>For Walden, that high price actually prompted him to take himself more seriously. He said the expense felt like an investment in him by the VA. After years on and off drugs, and in and out of jail, Walden, now 62, said he’s finally changing for the better. He said he no longer drinks or uses drugs, and is volunteering in hospitals, playing drums for patients.\u003c/p>\n\u003cp>The exorbitant prices of the new hepatitis C medications have led other health plans to hold off on treating every patient. Medi-Cal, for example, gives treatment priority to patients that show evidence of liver damage, or those who could spread the virus, like active drug users.\u003c/p>\n\u003cp>While the VA initially also had \"treatment priorities,\" this policy changed in 2016, after Congress stepped up with \u003ca href=\"https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2762\" target=\"_blank\" rel=\"noopener noreferrer\">billions in funding\u003c/a>, and pharmaceutical companies released new versions of drugs that were more competitively priced.\u003c/p>\n\u003cp>These days, the VA will treat \u003cem>anyone\u003c/em> with any level of veterans benefits. For the veterans, the treatment is usually free. Some have a small co-pay for the entire course of treatment, with $33 as the maximum.\u003c/p>\n\u003cp>Health officials say hepatitis C could be eliminated as a public health risk by 2030, but it will happen only if other health plans copy the VA’s lead.\u003c/p>\n\u003cp>At the VA in Martinez, Bertilacchi-Green concludes the visit by showing Junius Wilson and his wife, Shelly Baker, his latest lab tests. Even though he still has a month to go on his medication, the virus is already undetectable in his blood.\u003c/p>\n\u003cp>Wilson and Baker smile at one another.\u003c/p>\n\u003cp>\"We're happy,\" Baker said. \"We still need him around for a long time.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Additional reporting by Carrie Feibel.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Vietnam-era veterans have a high prevalence of the virus. But new strategies and drug prices offer hope.","status":"publish","parent":0,"modified":1506058578,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":32,"wordCount":1197},"headData":{"title":"In the Battle Against Hepatitis C, the VA Takes the Lead | KQED","description":"Vietnam-era veterans have a high prevalence of the virus. But new strategies and drug prices offer hope.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"In the Battle Against Hepatitis C, the VA Takes the Lead","datePublished":"2017-09-21T21:57:55.000Z","dateModified":"2017-09-22T05:36:18.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"361087 https://ww2.kqed.org/stateofhealth/?p=361087","disqusUrl":"https://ww2.kqed.org/stateofhealth/2017/09/21/in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead/","disqusTitle":"In the Battle Against Hepatitis C, the VA Takes the Lead","audioUrl":"https://www.kqed.org/.stream/anon/radio/RDnews/2017/09/KlivansVetsHepC.mp3","path":"/stateofhealth/361087/in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Junius Wilson likes to dress up when he goes in for his appointments at the \u003ca href=\"https://www.va.gov/\" target=\"_blank\" rel=\"noopener noreferrer\">Department of Veterans Affairs\u003c/a> in Martinez. On a recent visit, the 67-year-old wore a black felt fedora and a sport coat. On his lapels, he wore a handful of military medals.\u003c/p>\n\u003cp>\"All these are medals from Vietnam,\" he said. \"The three stars are for warriors ... this one's national defense.\"\u003c/p>\n\u003cp>Wilson's wife, Shelly Baker, sat beside him. She nudged him to show off one medal, which hung from a violet ribbon: a Purple Heart.\u003c/p>\n\u003cp>Wilson got that one because he was shot in the foot diving for cover during battle. He was in the infantry in South Vietnam and saw a lot of combat.\u003c/p>\n\u003cp>But Wilson, 67, isn't here for that. He's come for a monthly consultation with a specialized VA nurse who oversees his hepatitis C treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The VA has implemented an aggressive effort to screen and treat all veterans under their care for the virus. Hepatitis C experts and advocates have praised the VA for its proactive approach, and say it should be a model for other government health programs, and even private insurers.\u003c/p>\n\u003cp>While about 1 percent of the U.S. population is infected with hepatitis C, veterans who use the VA have higher rates, 4.8 percent.\u003c/p>\n\u003cp>And Vietnam-era veterans like Wilson have an even higher rate, according to \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/24682941\" target=\"_blank\" rel=\"noopener noreferrer\">studies\u003c/a>, VA data and physicians. Not all Vietnam veterans use the VA for health care, but among those who do, 7.5 percent have tested positive for the virus.\u003c/p>\n\u003cp>It's unclear why, but there are several theories. One is simply the demographic overlap between Vietnam veterans and baby boomers. Members of the baby-boom generation have Hepatitis C infection rates five times higher than the average American. Hepatitis C, which is blood-borne, wasn't even identified as a distinct virus until 1989, and the baby boomers grew up in an era when blood wasn’t screened, and \u003ca href=\"http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)30002-0/abstract\" target=\"_blank\" rel=\"noopener noreferrer\">before disposable needles were common in medical settings\u003c/a>.\u003c/p>\n\u003cp>Some attribute the higher rate of Hepatitis C in Vietnam veterans to the injections they received before deploying: Troops sent to Vietnam were often vaccinated assembly-line style, with something called a jet injector. Instead of a needle, a jet injector uses high pressure to force a vaccine through the skin. Later, \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/11427278\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> showed that older versions of the device could \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00000744.htm\" target=\"_blank\" rel=\"noopener noreferrer\">transmit\u003c/a> a hepatitis virus from person to person, and it's no longer used in the military. While it is impossible to know if jet injectors spread the hep C virus, the VA has said it is \"\u003ca href=\"https://www.hepatitis.va.gov/provider/policy/military-blood-exposures.asp\" target=\"_blank\" rel=\"noopener noreferrer\">biologically plausible\u003c/a>.\"\u003c/p>\n\u003cp>Others point out that some veterans of this conflict used intravenous drugs while in Vietnam, or after returning to the U.S.\u003c/p>\n\u003cp>Hepatitis C is passed through the blood. About 3.5 million Americans have the virus, and it's believed that half of them do not know it. After the discovery of the virus in 1989, screening of the blood supply didn't begin until 1992.\u003c/p>\n\u003cp>The virus can lurk silently for years, slowly damaging the liver until symptoms appear, like pain, nausea and yellow skin. It kills \u003ca href=\"https://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html\" target=\"_blank\" rel=\"noopener noreferrer\">more Americans\u003c/a> than all other infectious diseases combined, including HIV. In 2014, the death toll reached an all-time high of 19,659.\u003c/p>\n\u003cfigure id=\"attachment_361111\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"wp-image-361111 size-medium\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg\" alt=\"VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C.\" width=\"800\" height=\"600\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-800x600.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-160x120.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-768x576.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1020x765.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-1180x885.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-960x720.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-240x180.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-375x281.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26624_IMG_7129-qut-520x390.jpg 520w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">VA pharmacist Diana Ruiz demonstrates how the VA tracks the status of veterans who have or had Hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The VA's push to find -- and cure -- every patient with the virus began three years ago.\u003c/p>\n\u003cp>This became feasible only when new hepatitis C medications came to market in late 2013. The new generation of drugs was a huge improvement over previous treatments. The older drugs required shots that were injected into the stomach, and the medications could have severe side effects: flulike symptoms and even mental health problems.\u003c/p>\n\u003cp>VA nurse Susan Bertilacchi-Green does not miss those days. A decade ago, the cure rate she observed from those older drugs was about 30 percent, she said.\u003c/p>\n\u003cp>\"That was then,\" she said. \"Now, we have new medications that are nearly 100 percent effective. They have little to no side effects. You can be treated in as little as eight weeks, and there's no shots anymore.\"\u003c/p>\n\u003cp>Since 2014, the VA has cured 96,000 patients of hepatitis C.\u003c/p>\n\u003cp>Vietnam veteran Roman Walden is one of them. He thinks he got the virus while injecting heroin in Vietnam, a habit that continued when he returned home to Oakland. Years ago, he tried treatment on the old drugs, but had to stop due to serious side effects. When the new drugs came out, he was hesitant to try treatment again. But with reassurance from Bertilacchi-Green, and other veterans who'd been cured, he yielded. This time, the treatment worked.\u003c/p>\n\u003cfigure id=\"attachment_361112\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-361112\" src=\"https://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg\" alt=\"Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of Hepatitis C. \" width=\"800\" height=\"613\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-800x613.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-160x123.jpg 160w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-768x588.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1020x781.jpg 1020w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-1180x904.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-960x735.jpg 960w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-240x184.jpg 240w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-375x287.jpg 375w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718-520x398.jpg 520w, https://ww2.kqed.org/app/uploads/sites/27/2017/09/RS26628_IMG_7004-qut-e1505974615718.jpg 1560w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Vietnam veteran Roman Walden has a renewed sense of life after being successfully cured of hepatitis C. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"I was really amazed at that,\" he said. \"But then what really got me was how much it cost, and that made me feel like the president of the United States. They were spending this much money on me?\"\u003c/p>\n\u003cp>Hepatitis C drugs have become notorious for their high cost. The wholesale price for a course of treatment can be over $100,000.\u003c/p>\n\u003cp>For Walden, that high price actually prompted him to take himself more seriously. He said the expense felt like an investment in him by the VA. After years on and off drugs, and in and out of jail, Walden, now 62, said he’s finally changing for the better. He said he no longer drinks or uses drugs, and is volunteering in hospitals, playing drums for patients.\u003c/p>\n\u003cp>The exorbitant prices of the new hepatitis C medications have led other health plans to hold off on treating every patient. Medi-Cal, for example, gives treatment priority to patients that show evidence of liver damage, or those who could spread the virus, like active drug users.\u003c/p>\n\u003cp>While the VA initially also had \"treatment priorities,\" this policy changed in 2016, after Congress stepped up with \u003ca href=\"https://www.va.gov/opa/pressrel/includes/viewPDF.cfm?id=2762\" target=\"_blank\" rel=\"noopener noreferrer\">billions in funding\u003c/a>, and pharmaceutical companies released new versions of drugs that were more competitively priced.\u003c/p>\n\u003cp>These days, the VA will treat \u003cem>anyone\u003c/em> with any level of veterans benefits. For the veterans, the treatment is usually free. Some have a small co-pay for the entire course of treatment, with $33 as the maximum.\u003c/p>\n\u003cp>Health officials say hepatitis C could be eliminated as a public health risk by 2030, but it will happen only if other health plans copy the VA’s lead.\u003c/p>\n\u003cp>At the VA in Martinez, Bertilacchi-Green concludes the visit by showing Junius Wilson and his wife, Shelly Baker, his latest lab tests. Even though he still has a month to go on his medication, the virus is already undetectable in his blood.\u003c/p>\n\u003cp>Wilson and Baker smile at one another.\u003c/p>\n\u003cp>\"We're happy,\" Baker said. \"We still need him around for a long time.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Additional reporting by Carrie Feibel.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/361087/in-the-battle-against-hepatitis-c-the-veterans-administration-takes-the-lead","authors":["8648"],"categories":["stateofhealth_11","stateofhealth_2442","stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_3167","stateofhealth_2808","stateofhealth_2867","stateofhealth_2519","stateofhealth_3168"],"featImg":"stateofhealth_361104","label":"stateofhealth"},"stateofhealth_228633":{"type":"posts","id":"stateofhealth_228633","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"228633","score":null,"sort":[1472062466000]},"guestAuthors":[],"slug":"l-a-county-treating-few-people-for-hepatitis-c","title":"L.A. County Treating Few People for Hepatitis C","publishDate":1472062466,"format":"standard","headTitle":"KPCC | State of Health | KQED News","labelTerm":{"term":2353,"site":"stateofhealth"},"content":"\u003cp>\"Adolfo\" was addicted to cocaine and heroin for 15 years.\u003c/p>\n\u003cp>\"Drugs are really horrible things,\" says Adolfo, who asked that his real name not be used. \"At the beginning, you do it to have fun but then it turns into a hell.\"\u003c/p>\n\u003cp>Although Adolfo eventually kicked his habit, he's left with the consequences of his IV drug use. He learned about 10 years ago that he has hepatitis C.\u003c/p>\n\u003cp>Today, Adolfo is one of the few patients that the Los Angeles County Department of Health Services has approved to receive powerful new drugs that effectively cure the virus.\u003c/p>\n\u003cp>Health Services, which provides health care for about half a million low-income people, started dispensing these drugs a little over a year ago. As of the beginning of this month, the department had approved hepatitis C treatment for a total of 160 people; 81 have completed or begun treatment.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Compare that with the San Francisco Health Network, which serves about 65,000 people overall. It began treating patients for hepatitis C a little less than two years ago. As of late June, it had treated 631 people for hepatitis C.\u003c/p>\n\u003cp>Dr. Hal Yee, L.A. County Health Services' chief medical officer and a liver specialist, personally reviews every treatment request. He defends his approach.\u003c/p>\n\u003cp>\"It's our obligation to offer treatment in a manner that's rational and logical,\" Yee says. \"We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now.\"\u003c/p>\n\u003cp>Yee has developed a checklist of criteria to determine if patients are eligible for treatment. His guidelines say patients should be drug-free for at least six months before getting hepatitis C medications.\u003c/p>\n\u003cp>\"We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs,\" Yee explains.\u003c/p>\n\u003cp>His approach differs from Medi-Cal's; the state Medicaid program expanded its guidelines last year to say active IV drug users should be treated for hepatitis C.\u003c/p>\n\u003cfigure id=\"attachment_228639\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228639\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS11986_137165920-800x537.jpg\" alt=\"pills\" width=\"800\" height=\"537\">\u003cfigcaption class=\"wp-caption-text\">Pills \u003ccite>(Philippe Hugue/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There' a lot of evidence to support treating people who inject drugs, because there's a very likely possibility that they will transmit the virus to someone else if they're sharing equipment for injecting drugs,\" says Emalie Huriaux, director of federal and state affairs for Project Inform, which advocates on behalf of people with hepatitis C.\u003c/p>\n\u003cp>\"One estimate I've seen is that one person with [hepatitis C] who's injecting drugs will transmit the virus to 20 other people,\" she adds.\u003c/p>\n\u003cp>Dr. Yee says he is willing to consider changing his six-month drug-free rule. But he also says that so far, he's had very few IV drug users requesting treatment.\u003c/p>\n\u003cp>Beyond this issue, Yee's general approach to treatment requests is more conservative than most. He doesn't believe everyone with the disease should be treated.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention says only a relatively small percentage of people with chronic hepatitis C will develop serious complications, such as liver cancer.\u003c/p>\n\u003cp>\"If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment,\" Yee says.\u003c/p>\n\u003cp>Here, too, Yee is somewhat of an outlier: The American Association for the Study of Liver Diseases recommends treating all patients with chronic hepatitis C. It says beyond liver problems, these patients are also at higher risk of developing heart and kidney disease.\u003c/p>\n\u003cp>But Yee says that time will validate his approach.\u003c/p>\n\u003cp>\"I know that if you come talk to me in one year, in five years, in ten years, you're going to see these numbers climb, because we've put in infrastructure that I know allows us to provide the kind of care that other counties can't even begin to think about,\" he says.\u003c/p>\n\u003cp>As part of that infrastructure, patients like Adolfo receive an array of services from a team of providers.\u003c/p>\n\u003cp>At a recent class at County-USC Medical Center, Adolfo learns about his virus and the medication he'll be taking. The Department of Health Services requires patients to attend this class before beginning treatment.\u003c/p>\n\u003cp>\"This was a really, really good class that I never expected,\" Adolfo says. \"I was sleeping and the hepatitis is alive.\"\u003c/p>\n\u003cp>Afterward, a clinical pharmacist and a nurse practitioner escort him to the lab, where he undergoes blood and urine tests, and then walk him to the pharmacy, where he will pick up his medication every two weeks.\u003c/p>\n\u003cp>Adolfo is eager to begin his treatment: \"I think this is more important than anything.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n","blocks":[],"excerpt":"L.A. County says patients should be drug-free for at least six months before getting hepatitis C medication. Medi-Cal recommends treatment for IV drug users.","status":"publish","parent":0,"modified":1472067317,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":791},"headData":{"title":"L.A. County Treating Few People for Hepatitis C | KQED","description":"L.A. County says patients should be drug-free for at least six months before getting hepatitis C medication. Medi-Cal recommends treatment for IV drug users.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"L.A. County Treating Few People for Hepatitis C","datePublished":"2016-08-24T18:14:26.000Z","dateModified":"2016-08-24T19:35:17.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"228633 http://ww2.kqed.org/stateofhealth/?p=228633","disqusUrl":"https://ww2.kqed.org/stateofhealth/2016/08/24/l-a-county-treating-few-people-for-hepatitis-c/","disqusTitle":"L.A. County Treating Few People for Hepatitis C","nprByline":"\u003cstrong> Rebecca Plevin \u003c/br> KPCC \u003c/strong>","path":"/stateofhealth/228633/l-a-county-treating-few-people-for-hepatitis-c","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\"Adolfo\" was addicted to cocaine and heroin for 15 years.\u003c/p>\n\u003cp>\"Drugs are really horrible things,\" says Adolfo, who asked that his real name not be used. \"At the beginning, you do it to have fun but then it turns into a hell.\"\u003c/p>\n\u003cp>Although Adolfo eventually kicked his habit, he's left with the consequences of his IV drug use. He learned about 10 years ago that he has hepatitis C.\u003c/p>\n\u003cp>Today, Adolfo is one of the few patients that the Los Angeles County Department of Health Services has approved to receive powerful new drugs that effectively cure the virus.\u003c/p>\n\u003cp>Health Services, which provides health care for about half a million low-income people, started dispensing these drugs a little over a year ago. As of the beginning of this month, the department had approved hepatitis C treatment for a total of 160 people; 81 have completed or begun treatment.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Compare that with the San Francisco Health Network, which serves about 65,000 people overall. It began treating patients for hepatitis C a little less than two years ago. As of late June, it had treated 631 people for hepatitis C.\u003c/p>\n\u003cp>Dr. Hal Yee, L.A. County Health Services' chief medical officer and a liver specialist, personally reviews every treatment request. He defends his approach.\u003c/p>\n\u003cp>\"It's our obligation to offer treatment in a manner that's rational and logical,\" Yee says. \"We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now.\"\u003c/p>\n\u003cp>Yee has developed a checklist of criteria to determine if patients are eligible for treatment. His guidelines say patients should be drug-free for at least six months before getting hepatitis C medications.\u003c/p>\n\u003cp>\"We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs,\" Yee explains.\u003c/p>\n\u003cp>His approach differs from Medi-Cal's; the state Medicaid program expanded its guidelines last year to say active IV drug users should be treated for hepatitis C.\u003c/p>\n\u003cfigure id=\"attachment_228639\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg class=\"size-medium wp-image-228639\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2016/08/RS11986_137165920-800x537.jpg\" alt=\"pills\" width=\"800\" height=\"537\">\u003cfigcaption class=\"wp-caption-text\">Pills \u003ccite>(Philippe Hugue/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\"There' a lot of evidence to support treating people who inject drugs, because there's a very likely possibility that they will transmit the virus to someone else if they're sharing equipment for injecting drugs,\" says Emalie Huriaux, director of federal and state affairs for Project Inform, which advocates on behalf of people with hepatitis C.\u003c/p>\n\u003cp>\"One estimate I've seen is that one person with [hepatitis C] who's injecting drugs will transmit the virus to 20 other people,\" she adds.\u003c/p>\n\u003cp>Dr. Yee says he is willing to consider changing his six-month drug-free rule. But he also says that so far, he's had very few IV drug users requesting treatment.\u003c/p>\n\u003cp>Beyond this issue, Yee's general approach to treatment requests is more conservative than most. He doesn't believe everyone with the disease should be treated.\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention says only a relatively small percentage of people with chronic hepatitis C will develop serious complications, such as liver cancer.\u003c/p>\n\u003cp>\"If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment,\" Yee says.\u003c/p>\n\u003cp>Here, too, Yee is somewhat of an outlier: The American Association for the Study of Liver Diseases recommends treating all patients with chronic hepatitis C. It says beyond liver problems, these patients are also at higher risk of developing heart and kidney disease.\u003c/p>\n\u003cp>But Yee says that time will validate his approach.\u003c/p>\n\u003cp>\"I know that if you come talk to me in one year, in five years, in ten years, you're going to see these numbers climb, because we've put in infrastructure that I know allows us to provide the kind of care that other counties can't even begin to think about,\" he says.\u003c/p>\n\u003cp>As part of that infrastructure, patients like Adolfo receive an array of services from a team of providers.\u003c/p>\n\u003cp>At a recent class at County-USC Medical Center, Adolfo learns about his virus and the medication he'll be taking. The Department of Health Services requires patients to attend this class before beginning treatment.\u003c/p>\n\u003cp>\"This was a really, really good class that I never expected,\" Adolfo says. \"I was sleeping and the hepatitis is alive.\"\u003c/p>\n\u003cp>Afterward, a clinical pharmacist and a nurse practitioner escort him to the lab, where he undergoes blood and urine tests, and then walk him to the pharmacy, where he will pick up his medication every two weeks.\u003c/p>\n\u003cp>Adolfo is eager to begin his treatment: \"I think this is more important than anything.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/228633/l-a-county-treating-few-people-for-hepatitis-c","authors":["byline_stateofhealth_228633"],"categories":["stateofhealth_11","stateofhealth_2746","stateofhealth_13"],"tags":["stateofhealth_2867","stateofhealth_2865"],"affiliates":["stateofhealth_2353"],"featImg":"stateofhealth_228636","label":"stateofhealth_2353"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You ask the questions. You decide what Bay Curious investigates. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. 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