Press release on NYC Health Department website:
July 28, 2016 – In recognition of World Hepatitis Day, the Health Department today released new data showing that many New Yorkers with hepatitis C are not yet diagnosed. A 2016 survey of nearly 5,000 adults at a large Bronx hospital showed that 40 percent (or two in five) of patients who screened positive for hepatitis C in a large hospital emergency department were previously undiagnosed. In contrast, only six percent of people who tested positive for the HIV virus were unaware of their infection. If left undiagnosed and untreated, hepatitis C can lead to cirrhosis, liver cancer, and premature death. Of all people whose blood was tested in this Bronx emergency department, seven percent had antibodies for the hepatitis C virus, a rate three times higher than the city’s average. The Health Department provides free hepatitis educational resources, trainings and technical assistance for health care and community-based providers as well as the general public. To learn more or find hepatitis C testing, care and treatment services in New York City, go to nyc.gov/health/hepatitis or contact email@example.com.
“Hepatitis C can be treated and cured, an opportunity we rarely have with viral diseases. This is why the Health Department strongly recommends that health care providers screen at-risk patients and all ‘baby boomers’, that is, those born between 1945 and 1965, for the virus,” said Health Commissioner Dr. Mary T. Bassett. “Despite progress in getting people tested and into treatment for hepatitis C, these new data show there are many more people with hepatitis C that we need to reach. Last fall, we launched the Hepatitis C Clinical Exchange Network to provide training and clinical mentoring to physicians at 34 hospitals citywide to increase screening, diagnosis, care and treatment of hepatitis C.”
“The results are a ‘tale of two cities.’ Just over 30 years into the HIV epidemic, our results show the spectacularly successful efforts to identify people living with HIV in the Bronx and throughout the city of New York,” said Dr. Barry Zingman, one of the authors of the study. “But the hepatitis C results show that we need to be doing much more to truly control this disease.”
“Hepatitis C infection is typically seen among older adults, those born between 1945 and 1965, many of whom have been living with the virus for years,” said Fabienne Laraque, Medical Director of the Viral Hepatitis Program. “But we are seeing a significant number of hepatitis C infection in younger people, a finding that is alarming.”
“Unfortunately, this study confirms this disease’s status as a silent presence in our communities that continues to take its toll on our family, friends, and neighbors,” said Council Member Margaret S. Chin. “That is why our efforts to increase funding for preventive and treatment services for Hepatitis B and C are so crucial in addressing this epidemic. As we gather together to observe World Hepatitis Day, I urge New Yorkers to get tested and into care as soon as possible to avoid serious illness.”
Of 146,500 people estimated to be infected with hepatitis C in New York City, only about 9 percent have been cured, despite the availability of new, highly effective and easy to tolerate oral treatments. Neighborhoods with the highest rate of newly reported chronic hepatitis C infection per 100,000 people are in the Bronx and Manhattan while Brooklyn has the greatest number of people reported with chronic hepatitis C.
Study findings also showed that 81 percent (about four in five) of people ages 21 to 29 who screened positive for hepatitis C had not been diagnosed previously. According to recent Health Department data, about 12 percent of people newly reported with hepatitis C in New York City are under 30 years of age.
Close to a third of people in the study who tested positive for HIV were also tested positive for hepatitis C. People living with both HIV and hepatitis C infections have worse health outcomes than those with either HIV or hepatitis C alone.
“Thanks to our Bronx Knows campaign to increase HIV testing, we’ve been able to reduce the number of people living with HIV who have never been diagnosed from 14 percent in 2010 to 6 percent in 2015,” said Dr. Demetre Daskalakis, Assistant Commissioner of HIV/AIDS Prevention and Control. “We believe the same can be done for hepatitis C with similar efforts to mobilize communities and medical providers to increase hepatitis C testing.”
To address the under-diagnosis of hepatitis C in the Bronx and other high-burden neighborhoods in New York City, the Health Department has initiated new programs to strengthen the health care system’s response to the epidemic. In 2015, the Health Department’s care coordination and navigation programs helped more than 3,500 New Yorkers learn how to prevent hepatitis C, get tested, or access hepatitis C care and treatment. Launched last fall, the Hepatitis C Clinical Exchange Network provides training and clinical mentoring to physicians at 34 hospitals citywide to increase screening, diagnosis, care and treatment of hepatitis C.
“The Hepatitis C Clinical Exchange Network fills a much needed gap in medical training in hepatitis C,” said Dr. Russell Perry, Bronx Lebanon Hospital Center and Hepatitis C Clinical Exchange Network Champion. “It leverages the expertise of local clinicians who have treated hepatitis C for years, and offers a platform for knowledge sharing with providers seeking to improve hepatitis care at their own hospitals.”
Starting in 2014, the New York City Council funded hepatitis B and C patient navigation services at community health centers and harm reduction programs citywide. These programs served 2,471 patients in Fiscal Year (FY) 2015, providing outreach, prevention, health coaching, linkage to care and care coordination services. In FY16, nearly $975,000 was allocated toward community health centers to improve treatment for hepatitis B and C, enhance prevention services, and provide training to health professionals. In addition, this City Council funding allows the Empire Liver Foundation, an association of hepatologists, to provide clinical capacity building to improve providers’ ability to treat and care for hepatitis C at medical facilities throughout the city.
Research conducted by the Health Department’s Viral Hepatitis Program from June to November 2014 shows that the most common factors cited by providers and patients as barriers to hepatitis C treatment were active alcohol or drug use, other medical conditions, and mental health issues. These issues are being addressed by the Viral Hepatitis Program’s latest initiative – Project INSPIRE. The three-year demonstration project seeks to improve health care and lower costs for hepatitis C patients through care coordination.
To date, Project INSPIRE has enrolled more than 2,000 patients in a program designed to support them through hepatitis C treatment while managing their co-morbidities, including mental health and substance abuse issues. Enrollees are expected to achieve cure rates of 90% for non-cirrhotic patients and at least 50% for cirrhotic patients. Through a cost analysis and development of a new payment model, the project aims to demonstrate that care coordination supports patients through cure, reduces hospitalizations and emergency room costs, and reduces long-term complications of hepatitis C infection. Project INSPIRE works with Mount Sinai and Montefiore Medical Centers in Upper Manhattan and the Bronx, where the burden of hepatitis C is the highest in the city.
The Health Department’s Viral Hepatitis Program offers free resources to support health care providers in hepatitis B and C screening and care. These resources include regular in-person trainings for health care and social service providers on hepatitis B and C-related topics, as well as print and online educational resources for patients and providers. In addition, the Program is the lead organizer for Hep Free NYC, a citywide network of community-based organizations, health care organizations, providers and advocates organized to address hepatitis B and C in the city and of the HCV Clinical Provider Network.