National Hepatitis Testing Day: Ask the Expert, Corinna Dan

National Hepatitis Testing Day in the United States is part of an educational initiative of CDC's Division of Viral Hepatitis and the U.S. Department of Health & Human Services' Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care & Treatment of Viral Hepatitis, Updated 2014-2016 .

Corinna Dan, R.N., M.P.H., is Viral Hepatitis Policy Advisor, Office of HIV/AIDS and Infections Disease Policy, U.S. Department of Health and Human Services, and National Hepatitis Testing Day.

Q: Why do you think the public does not perceive hepatitis C as a public health concern?

Corinna Dan: There are three main reasons that the American public does not understand that hepatitis C virus (HCV) is a public health concern. The first is that the HCV virus was only identified in 1989 and we have only had a test for it since 1992. There is still a lot we don't know about the virus and many people who still haven't heard of it. The second is that most people who are chronically infected have not been diagnosed. We expect that as more people are diagnosed and get into care they will share their experiences of being tested and cured with others, thereby increasing awareness among their families and communities. The third reason that awareness is low is that HCV often causes mild symptoms or no symptoms at all for many years following infection. Many people who are chronically infected with HCV have a little reason to suspect that they are infected and when symptoms do occur, they are often very general like fatigue or joint aches and don't immediately suggest an HCV infection.

Another challenge for HCV awareness today relates to the legacy of past treatments that were poorly tolerated and often not effective. Treatments available before 2011 were only about 50% effective in curing people and required 48 weeks of taking injectable medications associated with many side effects. Some people who may have been tested in the past were discouraged from taking these earlier, less effective treatments for a variety of reasons, including: medical contraindications, concern about side effects, lack of insurance coverage, and poor provider knowledge. Now that we have a cure for HCV that only requires 8–24 weeks of treatment with very few contraindications or side effects, it is more important than ever to increase awareness and get people tested, into care, and considered for treatment.

Q: How do you think the Affordable Care Act affects hepatitis C prevention activities, care, and treatment?

Corinna Dan: The Affordable Care Act provides a number of opportunities to improve HCV prevention, care, and treatment. First, it prohibits exclusion from health insurance due to pre-existing conditions. Prior to the passage of the Affordable Care Act, many people with chronic HCV were unable to qualify for health insurance coverage.

A second opportunity is through the requirement of coverage for clinical preventive services. Because of the Affordable Care Act, preventive services that have a US Preventive Services Task Force grade "A" or "B" and vaccines recommended by the American Committee on Immunization Practices are available free of copay. This includes testing for hepatitis B for pregnant women, hepatitis C for people born from 1945-1965, and hepatitis A and B vaccines. In June 2015, hepatitis B testing for people born in countries with a high prevalence of chronic hepatitis B, such as those in Asia and Africa, will be added to this list of preventive services that should be offered without copay.

Another way that the Affordable Care Act can increase HCV prevention opportunities is the extension of coverage for dependent on their parents' health insurance to age 26. This is important because the Centers for Disease Control (CDC) and Prevention has identified an increase in new HCV infections of over 150 percent between 2010 and 2013 in the U.S., largely among people younger than 30 years of age. The CDC found that most people who are newly infected with HCV had started using oral prescription opioids and then transition to injecting opioids and/or heroin. The expanded dependent coverage provides opportunities to engage young people in prevention, testing, care, and treatment for HCV as well as treatment for substance abuse disorders, as needed. As we work to address the increase in new HCV infections, we must consider how to make the best use of this provision of the Affordable Care Act.

Q: Hepatitis C affects a lot of people who are in recovery. What steps should substance abuse treatment programs consider taking to help their clients with hepatitis C?

Corinna Dan: Substance abuse treatment programs should consider:

• Educating their patients and staff,
• Regularly offering or referring clients to get tested for HCV and other bloodborne viral infections,
• Sponsoring hepatitis C support groups, and
• Developing pathways to HCV care and treatment for their clients.

The Veterans Health Administration and the CDC's Division of Viral Hepatitis have excellent HCV patient and healthcare provider materials that are up-to-date and free of charge. The CDC recently released a new manual, a Guide to Comprehensive Hepatitis C Counseling and Testing . Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a Treatment Improvement Protocol (TIP) #53 Addressing Viral Hepatitis in People with Substance Use Disorders to increase knowledge of viral hepatitis among staff in behavioral health programs that provide substance abuse treatment and provide guidance to substance abuse treatment program administrators regarding how to add or enhance virus hepatitis services. While this TIP was developed before the advent of new therapies, many of its recommended programmatic activities remain useful and relevant today. Importantly, given the link between behavioral health and hepatitis C, SAMHSA’s new Federal Guidelines for Opioid Treatment Programs includes recommendations for steps that opioid treatment programs should take to address viral hepatitis as well as HIV.

For more information about hepatitis C, visit the US Department of Health and Human Services Viral Hepatitis page and follow Ms. Dan's blog at blog sectionLearn more about the new ATTC resource, HCVCurrent, by joining a free ATTC webinar on Thursday, June 25: Hepatitis C Training for Healthcare Professionals: The HCV Current Initiative Exit Disclaimer

Ms. Corinna Dan, RN MPH, is the Viral Hepatitis Policy Advisor in the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) at the US Department of Health and Human Services, where she works to implement the National Viral Hepatitis Action Plan and support coordination of viral heptitis activities across federal agencies and the community. Prior to joining the OHAIDP, Corinna served as Hepatitis B Policy Fellow at the Association of Asian Pacific Community Health Organizations (AAPCHO). In this role, Corinna worked with community leaders and policy makers to promote improved prevention, diagnosis, treatment and care of viral hepatitis in Asian American communities across the United States. Corinna received a Bachelor of Science in Nursing from Rush University in Chicago and Masters in Public Health from the University of Illinois at Chicago.