Cherokee Nation Works to Overcome Barriers to Hepatitis C Care


With its Cherokee Nation Hepatitis C Elimination program, they have worked diligently to increase screening and get people into the continuum of care.

What You Need to Know

The Cherokee Nation Health Services program in Oklahoma has made significant progress in addressing hepatitis C. They have been actively working on increasing screening and ensuring infected individuals receive care and treatment.

The CDC has developed universal testing guidelines and released reports on hepatitis surveillance.

The Biden administration wants to establish a National Hepatitis C Elimination Program and have allocated substantial funding, including $6.1 billion for its setup and $11.3 billion for addressing program costs.

Hepatitis continues to be a significant health initiative identified by the US federal government. The Biden administration wants to establish a National Hepatitis C Elimination Program, dedicating $6.1 billion to set it up and a total of $11.3 billion to address the program’s costs.

For its part, the CDC has developed universal testing guidelines and released reports and progress on hepatitis.

The federal agency recently published its Viral Hepatitis Surveillance Report – United States, 2021which details the incidence rates during that time period. One of the major concerns is that hepatitis C (HCV) rates did increase during that time; whereas hepatitis A and B infection rates decreased. (One caveat for the decreases in HAV and HBV is that the authors of the report point out that the pandemic may have affected statistics.)

Nonetheless, the CDC’s accounting of incidence rates for 2021 and the figures on hepatitis C have continued a disturbing trend. During 2020-2021, the infection rates increased 14%. This is after hepatitis C rates doubled during 2014-2020.

There were 5023 reported cases of hepatitis C with 69,800 estimated infections, and 43 states reported 107,540 newly cases according to the CDC.

The CDC also recently published its 2023 National Viral Hepatitis Progress Report to offer some perspective on progress toward 2025 outcome goals for new viral hepatitis infections and viral hepatitis–related deaths—overall and for key populations.

In the report, the CDC noted the American Indian and Alaska Native populations experienced high mortality rates.

“The death rates for hepatitis C among non-Hispanic American Indian/ Alaska Native persons and non-Hispanic Black persons were 3.4 times and 1.7 times, respectively, the death rate among non-Hispanic White persons.”

A Novel Program Addressing a Population at Need

The Cherokee Nation Health Services program in Oklahoma has been working towards increasing hepatitis C screening, and getting people who are infected with the virus, into the continuum of care.

Whitney Essex, MSN, FNP-BC is a family nurse practitioner for Cherokee Nation Health Services (CNHS) and works in the infectious diseases department where she is the coordinator for the Cherokee Nation Hepatitis C Elimination program.

She has been involved in the program since its inception in 2015, and was an investigator in 2 studies—one looking at nearly the first 2 years of the program and then studying 5 years of the program.

In the first study, the results were published in JAMA Network Open.

“First-time HCV screening coverage increased from 20.9% to 38.2%, and identification of current HCV infection and treatment in newly screened individuals increased from a mean (SD) of 170 (40) per year to 244 (4) per year and a mean of 95 (133) per year to 215 (9) per year, respectively,” the investigators wrote in the first study.

“We started universal screening for hepatitis C in Cherokee Nation several years before the CDC made it a recommendation,” Essex said in an interview with Contagion. “And so I think that is where successes really started. We're finding patients and knowing that they had hepatitis C. Because it is so silent, many patients don't know they're infected. And, so the universal screening was a big turning point where we were able to track these patients down, and let them know about the hepatitis C diagnosis and get them treated.”

In addition, the program set out goals to get patients into care and document cures.

“During the implementation period, of the 793 individuals with current HCV infection accessing the CNHS, 664 were evaluated (83.7%), 394 (59.3%) initiated treatment, and 335 (85.0%) had documented cure. In less than 2 years, the 85% 3-year goal was reached for cure (85.0%), and the goal for linkage to care was nearly reached (83.7%), whereas screening (44.1%) and treatment initiation (59.3%) required more time and resources,” the authors wrote in their first study.

In the second study, Essex and her fellow investigators reported on their first 5 years of progress with the program. Their findings were published in the CDC ‘s Morbidity and Mortality Weekly Report earlier this year.

Overall, screening levels remained high and the treatment challenge remained. Specifically, the Cherokee program identified 1423 people who were diagnosed with HCV infection. In this group, 86% were linked to care, but only 61% initiated treatment and 56% completed treatment. However, for those who completed treatment it was found to be highly effective, with 99% of those who did so being cured.

The Cherokee program has seen its successes especially getting people diagnosed and acknowledges the challenges of getting people into treatment and completing it.

“On that continuum of care, there's just so many places for patients to get lost—too many steps along the way,” Essex said. “And we've talked about point of care testing and the importance of being able to give someone a diagnosis right at the time of testing.”

Continuing Forward With Federal Aid

The CDC acknowledges more work needs to be done. Hopefully, the combination of local grassroots programs such as the Cherokee Nation's combined with the backing of the federal government will continue the progress that has been made already.

“I think as we move forward with the political situation with funding available for hepatitis C elimination in the US, we're hoping that a lot of these barriers are broken down, and the continuum of care will improve just from that,” Essex said.

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