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HCV epi overview

HCV epi overview. Brigg Reilley, NPAIHB, Nat’l Program Epidemiologist, brigg.reilley@ihs.gov. In 20 minutes, we will cover. Transmission/trends Screening HCV estimates: national, IHS, OK (federal), Cherokee. Disclosures. My powerpoint formatting skills are truly apalling.

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HCV epi overview

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  1. HCV epi overview Brigg Reilley, NPAIHB, Nat’l Program Epidemiologist, brigg.reilley@ihs.gov

  2. In 20 minutes, we will cover • Transmission/trends • Screening • HCV estimates: national, IHS, OK (federal), Cherokee

  3. Disclosures • My powerpoint formatting skills are truly apalling

  4. Risk Factors for Transmission of Hepatitis C Heterosexual Sex Male-Male Sex Mother to Child Injection Drug Use Blood Products Needlestick Injury

  5. Hepatitis C Prevalence (NHANES estimate) 3.2 Million HCV Antibody positive Possibly up to 7.1 Million HCV Antibody positive in US Armstrong GL, et al. Ann Intern Med. 2006;144:705-14.;Chak E, et al. Liver Int. 2011;31:1090-1101

  6. NHANES Survey, United States, 2001-2008Awareness of HCV Infection Status Knowledge of HCV Infection Unaware of HIV infection21% Source: Denniston M, et al. Hepatology. 2012:55:1652-61.

  7. NHANES Survey: United States, 1988-1994 and 1999-2002Prevalence of HCV Antibody, by Year of Birth 7.0 1945-1965 1988–1994 6.0 1999–2002 5.0 4.0 HCV Prevalence(%) 3.0 2.0 1.0 0 1910 1920 1930 1940 1950 1960 1970 1980 1990 Year of Birth Source: Armstrong GL, et al. Ann Intern Med. 2006;144:705-14.

  8. A 300% Increase in Hepatitis C –related Hospitalization for AI/AN – 1995-2007 Byrd KK, et al Pub Hlth Rep 2011

  9. HCV related mortality (CDC National Surveillance data, 2016) • Rates nationally and among AI/AN dropped slightly from 2015-2016 • But rates remain the highest of all race ethnicities by far and double the national rate (10.75/100,000 among AI/AN, 4.45/100,000 nationally)

  10. OSDH recommends testing for the following persons: • Anyone born from 1945 through 1965. • Anyone who has injected drugs, even just once or many years ago. • Anyone with certain medical conditions, such as chronic liver disease and HIV or AIDS. • Anyone who has received donated blood or organs before 1992. • Anyone with abnormal liver tests or liver disease. • Anyone who has been exposed to the blood from a person who has Hepatitis C. • Anyone on hemodialysis. • Anyone born to a mother with Hepatitis C

  11. OK state data, 2015 acute HCV • In 2015, a total of 92 cases reported and confirmed as acute HCV in Oklahoma. • 53.3% of these cases were among males, while 46.7% were females. • Age group 25-29 years of age had the most cases and highest rates of all the diagnosed acute cases (21.7%). • Whites made up 56.5% of the acute HCV cases were White. • 80.3% of acute HCV patients reported having two or more sexual partners, while 62.5% reported using needles for street drugs

  12. Chronic Hepatitis C Infection Disproportionately Affecting Oklahomans; OSDH Encourages TestingFor Release: April 26, 2017 • According to a newly released study, there are an estimated 94,200 Oklahomans living with Hepatitis C virus infection. Estimates were developed by researchers at Emory University in conjunction with the Centers for Disease Control and Prevention to better understand the number of people in each state living with Hepatitis C. • The Oklahoma State Department of Health (OSDH) is encouraging residents to be tested for the virus as Oklahoma had the highest estimated prevalence in the nation at 3.34 percent, while the national prevalence was 1.67 percent. The report also indicates 523 Oklahomans died due to Hepatitis C from 1999-2012, ranking our state among the highest for Hepatitis C mortality.

  13. Recommended Testing Sequence for Identifying Current Hepatitis C Virus (HCV) Infection HCV antibody + Reactive Nonreactive - - HCV RNA + Detected Not detected Current HCV infection No HCV antibody detected No current HCV infection STOP* Additional testing as appropriate† Link to care * For persons who might have been exposed to HCV within the past 6 months, testing for HCV RNA or follow-up testing for HCV antibody is recommended. For persons who are immunocompromised, testing for HCV RNA can be considered. † To differentiate past, resolved HCV infection from biologic false positivity for HCV antibody, testing with another HCV antibody assay can be considered. Repeat HCV RNA testing if the person tested is suspected to have had HCV exposure within the past 6 months or has clinical evidence of HCV disease, or if there is concern regarding the handling or storage of the test specimen. Slide courtesy AASLD Curriculum & Training Source: CDC. Testing for HCV infection: An update of guidance for clinicians and laboratorians. MMWR. 2013;62(18).

  14. HCV Screening 2012-2017, IHS federal sites, persons born 1945-1965

  15. Universal HCV Screening, Cherokee Nation From 8/16-12/17, the program screened 38,591 persons ages 20-69 for HCV HCV Ab+ test reflexes to RNA confirmation

  16. By Age Category (CNHS)

  17. By Sex (CNHS)

  18. HCV new diagnoses, IHS data

  19. IHS HCV new dx by age group, 2005-2015, national

  20. IHS new HCV dx by birth cohort, 2005-2015, national

  21. IHS new HCV dx by sex, 2005-2015, national

  22. IHS new HCV dx by region 2005-2015, (national data)

  23. Cascade of Care, OK sites

  24. Summary • OKC Area is doing well overall compared to other Areas, but each site needs support to address gaps in the Cascade of Care, namely • Linking HCV patients to care for RNA testing and Metavir scoring • Increasing number of HCV patients in treatment to cure existing patients in a timely manner

  25. Barriers ranked by SUs • SUs cited the main barriers to increasing HCV services as 1) needing more time to work on HCV clinical services, 2) contacting historical HCV patients to return to care for confirmation or treatment, and navigating the drug acquisition process.

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