Various barriers exist to eliminating the public health problems of hepatitis B and C in the United States and some of them affect both ending transmission and reducing the complications of chronic infection, according to a recently-issued report from the National Academies of Sciences, Engineering, and Medicine.
One such barrier is that only five states and two large cities are funded for comprehensive viral hepatitis surveillance. Without a clear understanding of who is most affected by the diseases, it is difficult to form a strategy to combat them, according to findings in the report.
Another barrier to eliminating these illnesses is that approximately two-thirds of those with chronic hepatitis B and half of people with chronic hepatitis C do not know they are infected, according to the report. Viral hepatitis often carries a stigma for infected patients. Shame and fear of a positive test result can keep people away from testing and care, undermining any public health elimination effort.
Both diseases are asymptomatic until the later stages. Most new cases of chronic hepatitis B in the US are in foreign-born people who may face language or social barriers to accessing care. Additionally, people newly infected with hepatitis C tend to be poorer and less educated than average; many use injection drugs. Such patients can be hard to screen and have less contact with the health system. Prisons are a promising venue in which to treat hepatitis C, but treatment is an expensive obstacle for the prison system, according to the report.
The high price of treatment also creates a tension in determining which of those patients should be a priority in receiving treatment, because those at most immediate risk of death are not necessarily those transmitting the virus.
This is the first report of a two-phase study; the second report, to be released in early 2017, will outline a strategy for meeting the goals discussed in the report. Many health officials have called for increase screening for hepatitis and increased access to treatment.
The study was sponsored by the US Centers for Disease Control and Prevention Office of Viral Hepatitis and the US Department of Health and Human Services Office of Minority Health.
National Academies of Science, Engineering, and Medicine. A National Strategy on the Elimination of Hepatitis B and C – Phase 1. Accessed: May 3, 2016.