Hepatitis C has reached a high level of awareness among the public in the past several years. It is hard to imagine that only 30 years ago this year, the virus was first identified and the name “non-A, non-B hepatitis” was replaced with “hepatitis C.”
Hepatitis C is a contagious infection of the liver caused by the hepatitis C virus (HCV). Hepatitis C is passed only by blood-to-blood contact from someone who is infected with hepatitis C. Since we were not able to screen for HCV in blood products until 1992, about three-quarters of infections occurred before this time. The other 25 percent of infected people tend to be in their late-20s, early 30s. At the current time, hepatitis C infections almost never occur from blood products. Most transmission occurs from sharing needles or injection equipment, vertical transmission, or through sexual contact, though inefficient. New cases of hepatitis C have increased more than 150 percent in recent years. About 85 percent of people with chronic infections are asymptomatic, so about half are unaware of their status.
Effective treatment for chronic hepatitis C remained elusive until fairly recently. Currently, most people can be cured of a chronic hepatitis C infection through taking a daily pill for 8 to 12 weeks. Unfortunately, reinfection is possible if risk factors continue.
The prevalence of HIV/HCV coinfection varies greatly by region, but it is thought to average about 25 percent in the United States. HIV greatly hastens the process of liver disease, and liver disease is the second-leading cause of death of people living with HIV. Bernard Branson, MD, formerly of the Centers for Disease Control, said he advocates for use of the HIV infrastructure to address hepatitis C because of the similarities between the diseases.
For the past year and a half, the Pennsylvania Expanded HIV Testing Initiative (PEHTI) has integrated HCV testing into our broader HIV testing initiative to help address the alarming increase in Hepatitis C in both the general population and among people living with HIV. PEHTI is a statewide (excluding Philadelphia County) collaboration with the Pennsylvania Department of Health (PA DOH) and Penn State University’s College of Education focused on the implementation of the CDC’s guidelines for routine integration of opt-out HIV screening into a broad range of general clinical care settings. Given the overlap of populations most at risk for infectious diseases, we coordinate our efforts with staff from the PA DOH (i.e., HIV, Hepatitis C and Sexually Transmitted Diseases) as well as county health departments and members of the Hep C Free Allegheny initiative.
PEHTI has greatly increased its efforts to curtail the rise of hepatitis C by increasing awareness and encouraging screening for HCV along with HIV for those at risk and uninsured. Our staff provides free technical assistance and in-depth training to clinic staff in Allegheny County and across the state related to both hepatitis C and HIV, including helping clinics to get the training needed to initiate or expand hepatitis C screening. To reduce the barriers to HCV and HIV testing among those with greatest need, we provide free HIV and HCV rapid test kits to meet the needs of those who are uninsured or require confidential testing. We also facilitate referral to care among our network of providers whenever possible. We often target areas hardest hit by the opioid epidemic, where the risk of rapid spread of hepatitis C and HIV is highest. While PEHTI is able to provide rapid test kits, training and literature throughout our jurisdiction, we are unable to fund many of the other expenses required to end hepatitis C (e.g., confirmatory testing and treatment).
In Pennsylvania and especially in Allegheny County, a group of passionate medical professionals and researchers, along with clinics and shelters, have come together to fight this silent epidemic, each providing a variety of services. In 2018, PEHTI provided 7,889 HCV tests to partners who were able to discover 2,562 people with HCV antibodies (32 percent). In many ways, the work of our collaborations is just getting started. Through the tireless efforts of groups like Adagio Health, Allegheny Health Network, Community Liver Alliance, Allies for Health + Wellbeing, Central Outreach & Wellness Clinic, and others, we are getting closer to the goal of stopping HCV every day.
Through expanded testing, we hope to make more people who are at risk aware of their HCV and HIV status in Allegheny County. We also plan to increase our outreach throughout our broader Pennsylvania jurisdiction and to identify and communicate best practices among all of our collaborating clinics and programs. Hepatitis C is commonly referred to as the ‘silent epidemic’ because it is so difficult to know if someone is infected. This team of dedicated professionals in Allegheny County and beyond, with help from the PA DOH and Penn State University’s College of Education, is doing everything it can to put an end to the silence.
This article was provided by the Pennsylvania Expanded HIV Testing Initiative, College of Education, Penn State University. For more information, contact firstname.lastname@example.org