Researcher comments on New York`s effort to wipe out hepatitis C

A physician who is about to begin serving on a New York task force that will guide the state's groundbreaking plan to eradicate hepatitis C transmission tells Addiction Professional that this effort reflects longstanding leadership in the state on this public health crisis.

Andrew H. Talal, MD, professor of medicine at the University at Buffalo's Jacobs School of Medicine and Biomedical Sciences, says New York in 2014 became the first state to legislate the screening of Baby Boomers for hepatitis C, which affects around 200,000 New Yorkers. When state leaders in July announced a Hepatitis C Virus Elimination Plan, with an initial investment of $5 million in state funds to support it, they said it was modeled after past efforts to eradicate HIV/AIDS in the state.

Talal says one area of focus for him as part of the task force that will advise the state on the HCV Elimination Plan will be linkages to care. He is currently principal investigator for a Patient-Centered Outcomes Research Institute (PCORI) study examining innovations for treating hepatitis C in patients with substance use disorders.

“The PCORI study is testing the hypothesis that telemedicine leads to better outcomes than usual care,” Talal says, with usual care usually consisting of a referral to another provider for a substance use treatment patient with hep C.

Previous research by Talal and colleagues in this area has suggested that patients being treated in an opioid treatment program (OTP) will accept telemedicine services for HCV treatment over time. The concept involves making both medication treatment for opioid dependence and medications for hepatitis C available at the same OTP site, to ensure integration and continuity of care. This takes advantage of the “captive audience” that daily OTP visits from methadone visits allow, Talal says.

The state task force is expected to convene its first meeting next month.

Plan highlights

The initial funding allocation for the Hepatits C Virus Elimination Plan will support education and also will reinforce the importance of harm reduction approaches, such as through patient navigation assistance within syringe exchange programs. Regulations will be revised to allow more nonprofit and government groups to distribute and collect syringes for the purpose of reducing disease transmission.

In addition, as of last July, Medicaid managed care entities in New York have been offering reimbursement for harm reduction services.

The opioid crisis certainly has contributed greatly to an increase in hep C cases in the state. Outside of New York City, hep C-related deaths in the rest of the state have now outpaced HIV-related deaths for more than a decade.

“The ability to eradicate hepatitis C nationwide is a tall order, especially given the magnitude of the opioid crisis,” Talal says. “But what we hear more now is talk of 'micro-elimination.' Can a community do this?”