The introduction of Hepatitis C Direct Acting Agents (DAA’s) has significantly altered the treatment paradigm. The combination of improved sustained viral response (SVR) rates, minimal adverse effects, and drastically shortened treatment duration provides a unique and important public health opportunity to reduce the nationwide epidemic, particularly in correctional settings. In 2015, the United States admitted approximately 10 million detainees in the jail setting.1 Studies report HCV prevalence rates in jail ranging from 13% to 31.1%; however, the true prevalence rate remains unknown due to minimal utilization of HCV screenings and limited surveillance.
Hepatitis C is a chronic condition for which a cure exists, but at a cost that is so high it often creates barriers to treatment. Even with the introduction of newer and more effective medications, cost-sharing mechanisms such as plan premiums, deductibles, co-payments, and coinsurance created barriers to treatment. This has produced a large pool of patients infected with HCV who are willing but unable to access a cure.1 Removing the barrier of costs associated with Hepatitis C medications while supporting optimal treatment provision is one of the many important roles of a pharmacist.
The Street Medicine component of the San Francisco Department of Public Health is a small team of providers and nurses who provide healthcare for people without homes who have trouble integrating into traditional healthcare settings. We provide drop-in clinic hours in an accommodating setting, and also provide healthcare on the streets, in parks, in SRO hotels, and in shelters. We work closely with several programs, including the Homeless Outreach Team, who work to connect the most at risk and chronically homeless to housing and other services. Our goal is to stabilize patients and transition them to traditional primary care. However, this can be a long process, so we take on most primary care goals with our patients.
In 2007, when I joined the staff at the San Francisco Department of Public Health (SFPDH) to coordinate HIV testing and prevention services in drug treatment programs, there was nobody working specifically on the hepatitis C virus (HCV) in any concerted way. While there was limited HCV antibody testing happening in conjunction with HIV testing in a few community based organizations (CBOs), little attention was paid to the growing HCV epidemic, despite the fact that in that year (and in the years since) deaths from HCV exceeded HIV-related deaths in the United States. We still have much work to do to realize our vision of HCV elimination in San Francisco, but a lot has changed in the past decade. The progress we have made is partially due to the policy and budget advocacy victories of organizations like the National Viral Hepatitis Roundtable, Project Inform, the California Hepatitis Alliance (CalHEP), the San Francisco Hepatitis C Task Force, and other groups working at the federal, state, and local levels.
Trans women have 49 times the odds of being HIV-positive than other adults, bearing a greater burden than any population in the world.[i] Access to trans-specific health care, educational and employment opportunities, and housing stability are a few of the factors impacting their risk. To date, no studies have determined the precise factors leading to HIV, and no interventions have been developed specifically for this community.
OTOP located at Zuckerberg San Francisco General Hospital is a highly respected and highly coveted safe environment, which our clients cherish and look to for some stability in an uncertain world. One of the greatest characteristics of OTOP is our non-judgmental nature, and how we treat every single client with the respect and dignity where our clients are allowed to be themselves. When the Hepatitis C clinic began admitting clients in July of 2016, the flow of clients allowed for it to become more than a clinic now offering Hepatitis C treatment, but a place where rejuvenation can occur in a community that can thrive to end Hepatitis C.
I am a textbook baby boomer from the swinging sixties. I contracted hepatitis B in 1969 and odds are that that was when I also acquired hepatitis C. Over the years, I was told that I had elevated liver enzymes from being exposed to hepatitis B and not to worry about it. No one explained to me that I could have chronic hepatitis B and/or non-A, non-B hepatitis (what hepatitis C was called before 1998, when the virus was isolated). No one mentioned to me that I was at risk of developing cirrhosis, liver cancer, and an entire host of related conditions.
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- HepC 101