Hepatitis C Treatment Rather than Prevention is More Profitable
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Overview
Originally Published: 07/29/2015
Post Date: 07/29/2015
by Tim Cheney | Chooper's Guide
Summary/Abstract
Hepatitis C Treatment Rather than Prevention is More Profitable critiques the recenly released The 2014 - 2016 Action Plan for the Prevention, Care and Treatment of Viral Hepatitis.
Content
Hepatitis C Treatment Rather than Prevention is More Profitable
The following observations are being put forth in response to the letter posted on the ONDCP blog entitled In Recognition of World Hepatitis Day and to the recently released The 2014 - 2016 Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. We realize that Mr. Botticelli is stuck in a political quagmire plagued by economic interests and neoliberalism. Simple definition of neoliberalism is that profits supersede human interests. This action plan is nothing short of an annuity for corporate America.
We also understand that people are dying as a result of the inability of the current congress to implement policy and appropriate sufficient funding to create and support programs that are the gold standard in preventing the transmission of blood borne diseases since the 1970's. These programs are known as syringe exchange programs (SEPS) needle exchange programs (NEPS) and needle and syringe exchange programs (NSP) and they have been in operation for over forty years in some countries.
Hepatitis C (HCV) is transmitted primarily by means of contaminated drug use paraphernalia used in injecting drugs. The action plan addresses education, research, screening and treatment but does not once endorse syringe exchange as an option to reduce the incidence and prevalence of Hepatitis C and B amongst persons who inject drugs (PWIDS). PWIDS are the largest and most persistent cohort of new Hepatitis C cases and the prevalence of chronic infection amongst PWIDs is estimated at 64% nationally with some urban areas reporting over an 80% chronic infection rate. Over the last three years, the incidence of new HCV cases has risen 45% primarily amongst young white adolescents and young adults who were previously using prescription opioids. The largest at risk population is the new, inexperienced injection drug user (IDU) who will not initially seek treatment in the beginning stages of use.
The Action Plan calls for "Innovative, effective, multi-component hepatitis C virus prevention strategies for PWID and other drug users should be developed and evaluated to achieve greater control of hepatitis C virus transmission" and neglects to emphasize the key variable which is prevention. There is only one mention of sterile syringe exchange programs but no implementation action. Simply put, we need to discard moralism and adopt a harm reduction ideology that emphasizes that we must meet people where they are and engage them. It is widely acknowledged and accepted that addiction is a disease not a volitional act of misconduct and as such our policies should be informed by medical science rather than moralism, economic interests and law enforcement. A dirty (used needle) contaminated by HCV transmits the disease.. a sterile needle does not. It is that simple. If the members of congress were concerned with the welfare of this highly stigmatized population, then they would appropriate the funding to establish syringe exchange programs.
Although the plan is extremely comprehensive and addresses research, education and treatment, it fails miserably in regards to prevention leaving us with a horse has already left the barn scenario.
The bottom line:
- IDU's will be at risk in communities that have no syringe exchange program.
- Infected IDU's will continue to transmit HCV to other IDU's.
- There are currently approximately 200 syringe exchange programs nationally to serve over 1 million IDU's which translates to an average caseload of 5,000 per exchange.
- Many states either do not allow or have syringe exchange programs.
- Syringe exchanges should be available to all IDU's.
- Prevention education is meaningless to an addict in withdrawal.
- There is no federal funding since 2011. No money translates to inadequate service levels and elevated rates of infection.
- The economics - An average price for a clean syringe is .08 and the average lifetime cost for treatment of HCV depending on genotype and medication ranges from 60,000 - 250,000. This figure does not include secondary health problems resulting from the infection nor loss of productivity.
- Syringe exchange programs are recognized as best practice for disease transmission prevention by the CDC, NIDA, AMA, United Nations, and the World Health Organization.
- Screening, research and treatment are important but will not significantly impact incidence in the PWID population.
- The true beneficiaries of the action plan are the pharmaceutical companies. Prevention (syringe exchanges) should be should be a funding priority.
- Discretionary allocations in Federal Substance Abuse Prevention and Treatment Block Grants should include syringe exchange programs.
- There is more money in treating viral Hepatitis than in preventing it.
Below: Posted by on July 28, 2015 at 10:50 AM EDT
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In Recognition of World Hepatitis Day
- Enhanced access to HCV testing based on the availability of rapid point-of-care tests and US Preventive Services Task Force recommendations for HCV screening among individuals at high risk for infection;
- Improved access to health coverage based on provisions of the Affordable Care Act and Federal parity protections; and,
- New HCV therapies that are effective in curing HCV in the majority of people who complete treatment.