Compared with that of the national average, American Indian/Alaska Natives (AI/ANs) have about double the incidence of acute hepatitis C virus (HCV) infection and HCV-associated mortality. That may be changing, at last—and fairly quickly.
In 2012, the IHS began implementing the national recommendations for onetime HCV testing in people at highest risk (those born between 1945 and 1965). And as of June 2015, the proportion of the birth cohort screened for HCV had shot up from 7.9% to 33%—a 4-fold increase in testing in just 3 years.
With better screening comes a need for better follow-up care. Because IHS facilities are decentralized, the CDC says, implementation of HCV testing is a local decision, based on capacity and priorities. Several IHS facilities have established follow-up care and treatment for people with HCV infection, but clinical capacity remains a “substantial barrier to providing the care and treatment necessary for cure,” the CDC says. Moreover, some primary care providers remain hesitant to provide treatment because they associate current HCV medications with complicated, lengthy, and poorly tolerated interferon-based treatments.
The majority of IHS patients obtain HCV medication at no cost through Medicaid and pharmaceutical assistance programs. It is unclear, the CDC says, whether this approach will be sustainable as a larger number of AI/AN people with HCV infection are identified and linked to care.
In the meantime, support for HCV testing has been integrated into existing programs, using methods and strategies (such as electronic health records as clinical decision support tools) that have been documented as successful in IHS facilities. Based on national best practices, IHS has also implemented clinical trainings and obtained telehealth support. Testing coverage in individual IHS facilities ranged from 1.9% to 75%—the largest increase was seen in facilities that used an electronic clinical decision support tool for testing.