Today is the last day of Hepatitis Awareness Month. Our final blog post of the month focuses on hepatitis C virus (HCV) and its disproportionate impact on people who inject drugs (PWID).

What is Hepatitis C?

Hepatitis C is a liver infection caused by HCV. For some people, HCV is a short-term, acute illness. Approximately 15%–25% of people clear the virus from their bodies without treatment and do not develop chronic infection. However, for 75%-85% of cases, it becomes a chronic infection that can result in long-term health problems, such as scarring of the liver, liver cancer, liver failure, and death. It is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States. Approximately 20,000 people die every year from HCV-related liver disease.

Last month, the Centers for Disease Control and Prevention (CDC) released new surveillance data on viral hepatitis in the U.S. showing that:

• From 2010 to 2016, reported cases of acute HCV increased 3.5-fold;
• Between 2015 and 2016, the number of reported cases of HCV increased 21.8%;
• An estimated 41,200 new HCV infections occurred in 2016; and
• American Indians/Alaska Natives had the highest HCV-related mortality rate compared with other racial/ethnic populations, and persons aged 55–64 years had the highest HCV-related mortality rate compared with other age groups.

Hepatitis C, the Opioid Epidemic, and People who Inject Drugs

The dramatic increases in acute HCV are being driven by rising rates of injection drug use. At the end of last year, the CDC published data showing that the national increase in acute HCV infection is related to the country’s opioid epidemic and associated increases in injection drug use, which is the primary risk factor for HCV. We will not be able to achieve our national hepatitis elimination goals if we do not provide comprehensive and compassionate prevention and treatment services to PWID. This month, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) updated their HCV screening and treatment recommendations to focus on eliminating HCV among key populations, including PWID, pregnant women who previously were not regularly screened, men who have sex with men, and individuals who are incarcerated.

The stigmatization of substance use disorder and discriminatory treatment policies have greatly impeded access to HCV services for PWID. Many state Medicaid programs often impeded access to treatment for PWID and 24 states require some period of sobriety for Medicaid patients to receive HCV therapy. Last year, the National Viral Hepatitis Roundtable and the Center for Health Law and Policy Innovation of Harvard Law School published “Hepatitis C: The State of Medicaid Access,” which illustrates the ways in which treatment restrictions keep Americans from being cured and prevent the elimination of the HCV epidemic.

Critically important to our efforts to address HCV among PWID is to scale-up comprehensive syringe services programs (SSPs). In addition to providing sterile needles, syringes, and other injection equipment, these community-based public health programs provide safe disposal containers for needles and syringes, HCV and HIV testing, education about overdose prevention, and referral to substance use disorder treatment, as well as other medical, mental health, and social services. SSPs are proven effective for reducing new HCV infections and must be a critical piece of our nation’s response to the opioid crisis. When using an SSP, PWID are five times as likely to enter treatment for substance use disorder and more likely to reduce or stop injecting. Expanding access to SSPs, especially in rural areas, is among the National Academies’ recommendations for eliminating viral hepatis. NACCHO also strongly supports the implementation and scale-up of SSPs.

Local Health Departments on the Frontlines of Addressing HCV among PWID

Local health departments (LHDs) are on the frontlines of addressing viral hepatitis and play a crucial role in supporting HCV prevention, care, and treatment. Now more than ever, LHDs must collaborate with their community, state, national, and federal partners to combat the rising rates of HCV. LHDs have a long history of addressing the HCV prevention needs of PWID, and are critical to the implementation and scale-up of comprehensive harm reduction services. Further, LHDs actively work to combat stigma and discrimination to ensure culturally competent services are available to PWID.

NACCHO is working closely with its members to respond to the infectious disease consequences of the opioid epidemic. NACCHO supported the LENOWISCO Health District in rural southwest Virginia to develop a comprehensive Community Response Plan for outbreaks of hepatitis and HIV among PWID. This recently released case study shares information about the process the health department took for developing the Community Response Plan, lessons learned, and next steps for putting the plan into action. NACCHO is currently supporting LENOWISCO’s efforts to start the first sanctioned SSP in Virginia, which will be located in Wise County. NACCHO is also working with the Kentucky River District Health Department in Kentucky and local partners in West Virginia to scale-up the availability of harm reduction services. All three of these efforts include a focus on community engagement and partnership development, such as convening town hall meetings and collaborating with local substance use coalitions.

To expand its efforts to support LHD initiatives to respond to the infectious disease consequences of the opioid epidemic, NACCHO recently established a Local Health Department Harm Reduction Community of Practice. The Community of Practice is currently being piloted with 11 LHDs that NACCHO was already working with on efforts related to the opioid epidemic. In the early fall, NACCHO plans to formally launch the Community of Practice and engage additional LHDs from across the country. The purpose of the group is to foster collaborative learning and knowledge sharing, and to identify and develop best practices and resources that can be shared broadly.

Although Hepatitis Awareness Month is ending, our efforts to address viral hepatitis continue every day. Visit NACCHO’s website to learn more and access resources to support your efforts. We also encourage you to review the National Viral Hepatitis Action Plan, 2017 – 2020 and its accompanying Partner Planning Guide to assess your existing activities and plan new ones that align with the Action Plan and contribute toward reaching our national viral hepatitis goals.