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1rem

, where we delve into some of the social factors that create and widen healthcare disparities.

In honor of World Hepatitis Day, we interviewed Carl Schmid, executive director of the 

, about the persistent challenges in the fight against 

Schmid acknowledged there are many diseases and health concerns plaguing the world right now, but World Hepatitis Day is a chance to pause and recognize “we still have hundreds of millions of people with hepatitis right now, and it’s an infectious disease.”

Schmid himself is living with chronic hepatitis B, and thus, “This issue is personally very important to me.”

The different types of hepatitis disproportionately affect different populations. Schmid notes that in the US, homeless people are often most affected by hepatitis A, while Asian Americans make up the majority of hepatitis B cases. In the US, all people are recommended for hepatitis B vaccination at birth; immigrants who may not have been vaccinated have a higher risk for hepatitis B.

Even though we have a vaccine for hepatitis B, and viral hepatitis treatments are better than ever, the opioid epidemic is significantly increasing hepatitis infection by injection drug use. “We’re seeing more and more younger people, and more and more women who are contracting hepatitis C,” Schmid said.

“Every 30 seconds,” Schmid says, “someone is dying of hepatitis, and the sad thing is people don’t even know about it.”

“Like HIV, there’s so much stigma…a lot of people feel shame, and they don’t talk about it,” Schmid said, pointing out that this stigma leads to many unnecessary deaths.

Schmid noted that the hepatitis testing recommendations have been changed, and now every person between 18 and 79 years of age should be tested, which should reduce the stigma.

“It all comes down to testing,” he emphasized.

Proper surveillance for hepatitis is another area that is sorely lacking. “We don’t even have enough money to do proper surveillance of hepatitis,” Schmid said, “We know surveillance is so important for infectious diseases.”

The HIV+Hepatitis Policy Institute is a Washington, DC-based policy and advocacy organization for HIV and viral hepatitis issues. They are currently working with Congress to help pass the Biden Administration’s push for more funding.

Schmid said we have a long way to go in the fight against hepatitis: “This is an infectious disease, remarkably, that can be cured,” but, “We need more resources.”

Missed Episode 5 of Contagion Community? 

Listen in on the conversation and feel free to offer your feedback on this episode, interest in participating in the podcast, or suggest ideas for future episodes. Please email your correspondence to Nina Cosdon: 

What steps need taken to end viral hepatitis by 2030? “It all comes down to testing,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute.

World Hepatitis Day: Where Do We Go From Here?

Social determinants, a legacy of distrust, and inequities have all been challenges for people of color in the delivery of health care. And these factors have translated to the administration of 

The university hosts the biggest vaccination site in its county, San Bernadino. However, there is low representation of Black vaccinees. Abdul-Mutakabbir and faculty at Loma Linda worked with leaders from local Black churches to get the word out and communicate about the availability and benefits of the COVID-19 vaccine.

“From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black,” Abdul-Mutakabbir and coauthors wrote in their poster.

Along with protection against COVID-19, Abdul-Mutakabbir makes the point that preventative measures such as vaccines can help avoid hospital stays and subsequent health care associated infections and antimicrobial resistance. She believes vaccination goes hand-in-hand with antimicrobial stewardship.

Hear what vaccine equity means to Abdul-Mutakabbir, and the vaccine drive in which she was involved.

Missed Episode 1 of Contagion Community? 

Listen in on the conversation and feel free to offer your feedback on this episode, interest in participating in the podcast, or suggest ideas for future episodes. Please email your correspondence to Nina Cosdon: ncosdon@mjhlifesciences.com

In this latest episode of Contagion Community, we interview Dr. Jacinda Abdul-Mutakabbir about vaccine equality vs vaccine equity as well as her experience on a COVID-19 vaccine drive to increase vaccinations in communities of color.

Vaccine Equality vs Equity with Dr. Jacinda Abdul-Mutakabbir

World Malaria day stories, update on measles outbreak, coronavirus antivirals showing strong results in testing, and more this week.

New Transgenic Rhesus Macaque Model Paves Way for HBV Therapy Development

Atea Pharmaceuticals will present the full clinical study at the upcoming EASL Congress in May. 

HCV Combination Therapy Meets Phase 2 Endpoints, Will Present Data at Conference

While 254 million affected globally with HBV, the disease remains endemic in Nigeria due to imperfect vaccination efficacy and limited coverage

Mathematical Model Highlights Challenges in Combating Hepatitis B in Nigeria

Universal hepatitis C screening updates have influenced testing numbers, and resulted in a gradual increase for all women with a pronounced increase in pregnant women. 

Hepatitis C Screening Increases in Women, Especially Those Who Are Pregnant 

Sarah Rowan MD on minimal lab testing, Hep B screening flexibility, peer navigation and state‑specific strategies to overcome outreach and reimbursement hurdles

Simplified Hepatitis C Protocols Raise Treatment Uptake and Cure Rates

 highlights the success of integrating Hepatitis C treatment into syringe services programs, leading to higher treatment initiation and cure rates among people who inject drugs, who often face significant care access barriers.

The review examined 13 US-based studies, including randomized trials, cohort studies, and qualitative evaluations, and found that integrated treatment models outperformed traditional referral-based care in terms of patient outcomes. The programs varied in approach, with some operating in mobile units and others in fixed settings, offering care both in person and via telehealth, and differing in pretreatment evaluations, pharmacy access, peer support, and funding models.

In this second part of our interview with Sarah Rowan MD, infectious disease physician at Denver Health and co-author of the review, she discusses recent follow-up efforts, streamlined treatment models, outreach challenges, and the need for tailored solutions.

“Hepatitis C treatment has just gotten so much safer and more streamlined than it was even five years ago, now that we have this minimal lab testing model and we know how safe and effective the treatments are,” Rowan said.

She highlighted ongoing discussions around hepatitis B screening protocols, “We know that it’s important to know someone’s Hep B status when you’re treating Hep C. But whether we can use some prior lab results, or we can get the blood work and then as long as it’s pending, and as long as we have a way to find someone, then go ahead and start Hep C treatment and not wait for those results. That’s one thing that’s in discussion, engaging really, at the moment, at the present time.”

Rowan also emphasized the importance of outreach in finding and treating individuals, “Sometimes people go to a fixed site syringe service program, but sometimes they might not be, you know, working through working order syringe access programs. So how best to find people to communicate results and to deliver medication, that’s something else that’s really been coming up a lot.”

Regarding the role of patient navigators, Rowan noted, “The role of the patient navigator, or peer navigator, or peer advocate in kind of helping people to stay on the medication so that they can get through a full treatment course and then come back and get that test of cure, is crucial.”

Rowan also discussed the logistical hurdles tied to reimbursement for these services, “Doing something kind of outside of the traditional clinic based model is challenging because of the way that reimbursement works in this country with Medicaid and commercial insurance, it’s highly variable state to state. But looking at the numbers of people who use drugs who get Hep C treatment, you can see that we have a problem because the people who need treatment are often not getting it.”

Finally, she underscored the importance of innovative, state-specific solutions, “Looking at creative approaches to problem solving within your state and within your system is key to addressing these disparities.”

Yoder T, Hirose K, Tsui JI, et al. Approaches to offering hepatitis C treatment at syringe services programs in the United States: a scoping review. Open Forum Infect Dis. 2025;ofaf211. doi:10.1093/ofid/ofaf211

Sarah Rowan, MD, on minimal laboratory testing, Hepatitis B screening flexibility, peer navigation, and state‑specific strategies to overcome outreach and reimbursement hurdles

Sarah Rowan MD says tailored models within syringe service programs can overcome barriers and improve cure rates in underserved populations

Integrated Hepatitis C Care in Syringe Service Programs Improves Outcomes for People Who Inject Drugs

 shows that integrating Hepatitis C virus (HCV) treatment into syringe services programs significantly improves treatment initiation and cure rates among people who inject drugs. This population has historically faced major barriers to accessing care.

The review analyzed 13 studies from across the United States. These included randomized controlled trials, cohort studies, and qualitative evaluations of treatment models located within syringe service programs. Compared to traditional referral-based models of care, the integrated approaches consistently showed better outcomes.

The programs used a variety of approaches. Some were based in mobile units, while others operated in fixed clinical settings. Providers delivered care in person or through telehealth. The programs also differed in how they handled pretreatment evaluations, pharmacy access, peer support, and funding.

Sarah Rowan, MD, infectious disease physician at Denver Health and a co-author of the study, explained that success often depended on tailoring the model to the needs of each program and community, “We did look at different models, and some of the models use on site providers at syringe access programs. Some of the syringe access programs are brick and mortar and others are mobile units,” Rowan said.

“And then there are different approaches to where the provider was. Sometimes a provider was on site, seeing patients, person to person, face to face. Other times, the provider was available via video visit so through like a telehealth model, and really both approaches, or sort of all the variety of approaches had their pros and cons, but in general, they really were tailored to fit the situation for the program and the clients and the providers and the state.”

Rowan gave her key takeaway, “I think the kind of take home message was that various approaches can all work very well as long as they're kind of developed in concert with the folks at the syringe access center and the clients that you'll be serving,” she said.

Rowan also pointed out ongoing barriers that limit access to Hepatitis C treatment for people who inject drugs, “I think the main barrier for people who inject drugs is access to providers. So right now, the current models generally request that people go to a clinic, and it's often an infectious disease clinic or a gastroenterology clinic, and that has not worked very well for a lot of people who just don't have the bandwidth in their lives,” she said. “The traditional model involves scheduled appointments, insurance, transportation needs. The barrier of the traditional system is what the problem is.”

Rowan described how barriers show up at multiple stages of care, “Sometimes the barrier is follow up labs, finding someone to share results, and then getting the medication to people, ensuring that they can get their full supply of medication. So sometimes people will get medication and then it's stolen or lost. So, having a safe place to store medication has been a big barrier, and then getting the follow up test of cure results that all of those have been really pretty big barriers in the traditional systems,” she said.

Yoder T, Hirose K, Tsui JI, et al. Approaches to offering hepatitis C treatment at syringe services programs in the United States: a scoping review. 

Sarah Rowan, MD, says tailored models within syringe service programs can overcome barriers and improve cure rates in underserved populations.










Andrew  Aronsohn, MD, assistant professor of Medicine University of Chicago Medical Center discusses the hepatitis C (HCV) screen and treat in one visit approach 

AASLD/IDSA Develop a New Hepatitis C Point of Care Test and Treatment Algorithm

For people who are battling HCV, there are a number of challenges to getting this patient population into the continuum of care, explains Andrew Aronsohn, MD, associate professor of Medicine, University of Chicago Medical Center.

“I think what's really important to think about when caring for people with hep C—both on an individual and a population basis—is that oftentimes, we're really focusing on helping very vulnerable populations,” said Aronsohn. “So these are folks that may be struggling with addiction; these are folks that may have difficulty with transportation or navigating huge health systems, or maybe undomiciled. Every time you set up another step for them to have to follow-up, you risking losing them to follow-up. There's a lot of data in HIV and even in hep C, that if you put this all into 1 visit and you can work on some education and actually give them medication in hand before they go out the door it is beneficial."

With these challenges, AASLD/IDSA (American Association for the Study of Liver Diseases/ Infectious Diseases Society of America) have partnered together to create a “screen and treat” algorithm. The algorithm provides guidance for clinicians to show them how to carry out this model and expedite the time needed to get tested and on HCV medication. 

Aronsohn is one of the chairs of the AASLD/IDSA HCV panel. He and others on the panel periodically update the guidelines to include new patient populations and the addition of new treatments and testing.

“This is a brand new algorithm. There was general treatment guidelines, and we did have a simplified treatment guidance that was a little bit easier, but this is not for every patient—that's really important,” Aronsohn said. “These updated treatment algorithms are for a certain subset of patients, which is spelled out in the algorithm itself…With the availability of point of care testing, that was the missing piece to actually do a test and treat pathway,” Aronsohn said.

Within this 1 clinical visit, there are few major aspects of the algorithm the panel wants to see providers perform during patient encounters, including: point-of-care HCV RNA testing, which allows for quick diagnosis; for those who test positive for the disease, give patients medication at that same encounter; test for hepatitis B and follow-up with patients if they test positive; and lastly, give patients an HCV RNA test 4 weeks after completion of therapy to determine if the virus has been cleared.

"This is just another option that providers can have in their armamentarium, if that makes sense for the population that they're taking care of,” Aronsohn said. “And really the big goal is we want to diagnose and treat as many people as possible for this entirely treatable disease that still kills.”

For those interested in downloading the algorithm, readers can go 

Andrew Aronsohn, MD, associate professor of Medicine, University of Chicago Medical Center, discusses the hepatitis C (HCV) screen and treat plan that looks to utilize a one visit approach to get people tested and on medication in the same patient encounter. 

AASLD/IDSA Develop a New Algorithm for Hepatitis C Point of Care Testing and Treatment 

Anchalee Avihingsanon, MD, PhD highlights 95.4% HIV suppression, 86.6% HBV suppression, and 52% ALT normalization after 48 weeks of B/F/TAF treatment in patients who switched from DTG+F/TDF.

At CROI 2025, Anchalee Avihingsanon, MD, PhD, principal investigator of the ALLIANCE study and researcher at the HIV-NAT at the Thai Red Cross AIDS Research Centre in Bangkok, Thailand, discussed findings from the ALLIANCE trial. This Phase 3 study evaluated the efficacy and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) compared to dolutegravir + emtricitabine/tenofovir disoproxil fumarate (DTG+F/TDF) in adults with HIV-1 and hepatitis B virus (HBV) co-infection.

The study demonstrated that B/F/TAF was noninferior to DTG+F/TDF for HIV-1 RNA suppression and superior for HBV DNA suppression at Week 48. Following 96 weeks of the randomized phase, participants who switched from DTG+F/TDF to B/F/TAF continued treatment for an additional 48 weeks in the open-label extension (OLE), showing continued success in managing both HIV-1 and HBV.

Avihingsanon explained the study design and results, "In this study, we enrolled 243 HIV and hepatitis B (HBV) co-infected participants who received one of two drug regimens: either bictegravir (BIC) plus emtricitabine (FTC) and tenofovir alafenamide (TAF), or dolutegravir (DTG) plus tenofovir disoproxil fumarate (TDF) and FTC. The backbone for hepatitis B treatment was either TDF or TAF, and our main goal was to compare these two drugs in terms of their effectiveness for both HIV and HBV treatment.”

“We had two primary endpoints: 1) HIV viral suppression, and 2) HBV viral suppression and HBV-related outcomes. The first phase of the study was a randomized phase, which lasted 96 weeks, where participants were assigned to one of the two regimens. After 96 weeks, patients who had been receiving the DTG+TDF regimen were given the option to switch to the BIC+FTC+TAF regimen. Of the 122 patients eligible for the switch, 89 chose to continue into the open-label extension phase for an additional 48 weeks.”

Avihingsanon outlined the positive impact of switching to B/F/TAF on HBV suppression and liver health, "At the end of the 96-week randomized phase, we observed that both regimens were equally effective at suppressing HIV viral load. However, the outcomes for hepatitis B were different. Starting from the 48-week mark, the TAF-containing regimen showed better results for HBV suppression and also higher rates of HBeAg (hepatitis B e-antigen) and HBsAg (hepatitis B surface antigen) loss, which are important markers of HBV replication and infection resolution.”

“Before switching to the TAF-based regimen, nearly 85% of patients had abnormal alanine aminotransferase (ALT) levels, indicating liver inflammation. After switching to the TAF-based regimen, almost 50% of patients achieved ALT normalization, which is important because abnormal ALT levels suggest ongoing liver inflammation, which can lead to liver fibrosis, cirrhosis, and liver cancer over time.”

Avihingsanon emphasized the importance of TAF in managing HIV and HBV co-infection, “For patients co-infected with HIV and hepatitis B, it's essential to consider both HIV and hepatitis B outcomes. The TAF-based regimen is very effective for both HIV and hepatitis B. Therefore, any regimen containing TAF should be preferred as the first-line treatment for HIV and HBV co-infected patients.”

She also compared TAF and TDF-based regimens, “Additionally, when comparing TAF-based regimens to TDF-based regimens, TAF has the advantage of being safer for renal and bone health. This is important for HIV co-infected patients because they often have a higher risk of renal toxicity and related kidney problems.”

Avihingsanon discussed the long-term goals of hepatitis B treatment, “In terms of hepatitis B serology, the ultimate goals of treatment are ALT normalization, HBeAg loss, and HBsAg loss. Achieving these goals suggests a functional cure for hepatitis B, especially when there is HBsAg seroconversion. This is the ideal outcome we want to see. If we can normalize liver function, it helps reduce the risk of liver inflammation, liver fibrosis, cirrhosis, and ultimately liver cancer in the long term.”

Avihingsanon concluded by highlighting the importance of addressing both infections and their comorbidities, “For HIV and hepatitis B co-infection, it's not just about managing HIV; we must also consider the hepatitis B co-infection and the long-term comorbidities. Hepatitis B increases the risk not only of liver cancer but also of ALT-associated hepatotoxicity. Therefore, we must focus on how to rapidly reduce hepatitis B DNA, decrease HBeAg and HBsAg, and normalize ALT levels. These are crucial steps to managing the co-infection effectively and preventing future liver complications.”

Avihingsanon A, et al. Virologic and Immunologic Outcomes at OLE W48 in Participants Who Switched to B/F/TAF After 96W of Initial Treatment With DTG+F/TDF. Poster #XXX presented at CROI 2025. March 9-12, 2025, San Francisco, California.

Anchalee Avihingsanon, MD, PhD presents results showing 95.4% HIV RNA suppression and 86.6% HBV DNA suppression after 48 weeks of B/F/TAF in HIV-HBV co-infected patients.

Conferences

ALLIANCE Study: B/F/TAF Achieves Sustained HIV and HBV Suppression

In Part 2 of our interview, Su H Wang discusses combating vaccine misinformation, preventing outbreaks, and highlight global health interconnectedness

Science Is Science: Navigating Clinical Trust Amid Political Shifts

Recent changes in US health policy have raised serious concerns within the global health community. In a recent Lancet correspondence, 

, and fellow clinicians and public health experts highlighted the alarming impact of the US administration’s decisions to withdraw from the World Health Organization (WHO), halt vital CDC communications, and freeze foreign aid. These actions have placed international health partnerships at risk and threaten progress made in disease control, particularly for vulnerable populations worldwide.

Experts agree that swift action is needed to restore these programs and safeguard the progress made in global health. The freezing of foreign aid, particularly programs like PEPFAR, which supports more than 20 million people, is of particular concern. The current situation is a stark reminder of how interconnected the world’s health systems are and how vulnerable these systems are to political shifts.

In Part 2 of our interview with Wang, the discussion shifted to the impact of these policy changes on vaccine strategies

 and public health communication, with a focus on maintaining public trust in vaccines. Wang highlighted the role of clinicians in combating vaccine misinformation and reinforcing the importance of vaccines as life-saving tools. “We’ve seen time and time again that it’s not always the facts that sway people, but the messages they hear from friends and family,” Wang explained. “Clinicians need to be ready to counter misinformation with stories that show how vaccines have saved lives.”

Wang offered examples of how the MMR vaccine has played a key role in preventing devastating diseases like measles encephalitis

, and how the Hepatitis B vaccine has contributed to a significant decline in liver cancer rates.

 "Vaccines prevent more than just immediate diseases—they prevent long-term health complications that can affect entire generations. The Hepatitis B vaccine alone has made incredible strides in reducing liver cancer rates, and reversing that progress would be catastrophic,” Wang said.

The conversation then turned to the average American's potentially nonintentional lack of awareness about global health systems and how they contribute to the consequences of these policy shifts. Wang pointed out that many people in the US fail to recognize the broader systems that support public health—systems that rely on international cooperation and funding. “What we’re seeing is that there’s a sense that if it doesn’t happen in my neighborhood, within my country’s boundaries, it doesn’t affect me,” Wang said. “But the reality is, global health is interconnected. Epidemics in one part of the world can, and do, affect us here in the US in ways we don’t often realize.”

“If you go into a hospital, all the devices you use have been approved, and there are complex systems in place to ensure your safety, from blood donation screenings to medication approvals,” Wang explained. “These systems, though often invisible, are crucial to our well-being. And when we ignore them, we risk undermining the very protections that keep us safe.”

Wang also emphasized the importance of clear communication in maintaining public trust, particularly in times of political uncertainty. “At times like these, good reporting and journalism are more important than ever. It's crucial that we share information from reputable sources and make sure the truth gets out to wider audiences. But it’s not just the media’s job—each of us has a role to play in our own spheres, whether it's within our families, communities, or patient populations.”

Addressing the growing vaccine hesitancy in the US, Wang warned of the potential consequences of reversing vaccination progress. “If we backslide, we’ll see outbreaks of diseases we thought were eradicated. Polio, measles, and Hepatitis B will make a comeback,” she said. "Our children, our future generations, will bear the brunt of this. We've made so much progress, especially with vaccines like Hepatitis B, which has dramatically reduced acute cases and prevented liver cancer. Reversing that progress would be disastrous.”

WHO reported that measles cases increased globally from 8·6 million in 2022 to 10.3 million in 2023.

 Now, concerns about the ongoing measles outbreak in Texas, where children have fallen ill.

 “Measles is incredibly transmissible, and this outbreak is a stark reminder of the consequences of vaccine reluctance,” she said. “These outbreaks could be avoided if we stay vigilant and continue to communicate the importance of vaccines.”

Wang summarized, "Some of what’s happening in politics is politics. But we must keep science, science. We need to reassure people that vaccines are safe, and that science stands firm even in the face of political transitions."

Listen to the first part of our interview here: 

US Health Policy Changes Threaten Global Public Health Cooperation

1. Wang S, Harrington M, Graham CS, Downs LO, Kagwanja N, Etyang AO, Iwuji C, Ndung'u T, Cowie BC, Kabagambe K, Matthews PC. Pathogens don't respect politicians: US federal disruption poses a new threat to global public health. Lancet Gastroenterol Hepatol. 2025 Feb 6:S2468-1253(25)00045-7. doi: 10.1016/S2468-1253(25)00045-7. Epub ahead of print. PMID: 39923777

2. Seitz A. Vaccine skeptic Robert F. Kennedy Jr. is sworn in as Trump’s health chief after a close Senate vote. 

. February 13, 2025. Accessed February 14, 2025. https://apnews.com/article/rfk-trump-health-secretary-vote-5dbefeef0537dc241e6fb33b8f2a748b

3. Di Pietrantonj C, Rivetti A, Marchione P, Debalini MG, Demicheli V. Vaccines for measles, mumps, rubella, and varicella in children. Cochrane Database Syst Rev. 2021;11(11):CD004407. Published 2021 Nov 22. Accessed February 14, 2025. doi:10.1002/14651858.CD004407.pub5

4. Flores JE, Thompson AJ, Ryan M, Howell J. The Global Impact of Hepatitis B Vaccination on Hepatocellular Carcinoma. Vaccines (Basel). 2022;10(5):793. Published 2022 May 17. doi:10.3390/vaccines10050793

5. World Health Organization. Measles cases surge worldwide, infecting 10.3 million people in 2023. WHO. Published November 14, 2024. Accessed February 14, 2025. https://www.who.int/news/item/14-11-2024-measles-cases-surge-worldwide–infecting-10·3-million-people-in-2023

6. Texas Department of State Health Services. Measles Outbreak–Feb. 14, 2025. Texas Department of State Health Services. Published February 14, 2025. Accessed February 14, 2025. https://www.dshs.texas.gov/news-alerts/measles-outbreak-feb-14-2025

Su H Wang, MD, FACP, MPH discusses combating vaccine misinformation, preventing outbreaks, and highlighting global health interconnectedness





Combining over 1,000 human antibodies, GIGA-2339 aims to achieve viral clearance and activate the immune system, offering a potential solution where current therapies fall short of providing a cure.

HCV / Hepatitis

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