Health Equity

 
 
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The hepatitis B and C epidemics and their unchecked growth among communities of color, people who inject drugs, immigrants, the incarcerated/returning citizens, and others are symptoms of larger systems of stigma and health inequity.

NVHR is committed to supporting health equity both from a hepatitis-specific and a broader systemic perspective, to improve the health status of those living with or at risk for hepatitis B and/or C infection, as well as our communities overall.

  • Disproportionately Impacted Communities
    • African Americans
    • Asian Americans and Pacific Islanders (AAPIs)
    • Baby Boomers and Veterans
    • People Who Inject Drugs (PWID)
    • Hispanics and Latinos
    • Native Americans
    • People Who Are Incarcerated and Returning Citizens
  • NVHR Involvement and Events
    • Adult Vaccine Access Coalition (AVAC)
    • Hepatitis Foundation International Summit
    • Hepatitis B Screening for High-Risk Communities
  • NVHR Documents
    • The Medical Case for Curing All Patients with Hepatitis C
    • The Kelly Report
    • NVHR & National LGBTQ Task Force Submit Comments to CDC 

Disproportionately Impacted Communities

African Americans

Hepatitis C disproportionately affects African Americans. From 1999-2002, HCV prevalence among African Americans (3.2%) was more than two times that of non-Hispanic whites (1.5%).  Chronic liver disease, often hepatitis C-related, is a leading cause of death among African Americans ages 45-64. African Americans also have the highest mortality rates of liver cancer, of which HCV is a major cause.

Download a copy of NVHR's fact sheet on hepatitis C in the African American community.

Asian American and Pacific Islanders (AAPI)

Asian American and Pacific Islanders (AAPIs) make up less than 5% of the total population in the United States, but account for more than 50% of Americans living with chronic hepatitis B. Nearly 70% of AAPIs living the US were born, or have parents who were born, in countries where hepatitis B is endemic.

Most AAPIs with hepatitis B were infected as infants or young children: approximately 1 in 12 AAPIs are living with chronic hepatitis B. In addition, hepatitis B-related liver cancer incidence is highest among AAPIs and the leading cause of cancer deaths in this population.

 

Baby Boomers and Veterans

More than 75 percent of Americans living with hepatitis C are Baby Boomers (born between 1945-1965), and many remain undiagnosed and unaware of their infection. Baby Boomers account for approximately 75% of deaths caused by hepatitis C each year, and an estimated 35% of undiagnosed Baby Boomers already have advanced liver disease. NVHR’s fact sheet outlines the urgency of screening this at-risk population.

Veterans from the Baby Boomer generation (born between 1945-1965) are at a higher risk of being having hepatitis C than any other Veteran group, according to report by Population Health Services. The Veterans Health Administration's Office of Patient Care Services - Population Health Services, reports that Baby Boomer Veterans had a hepatitis C infection rate more than five times higher than other Veterans, and Veterans born in 1954 had the highest infection rate at 18.4 percent.

 

People Who Inject Drugs (PWID)

Sharing injection equipment is the most common way hepatitis C is spread in the United States, placing people who inject drugs (PWID) at high risk for contracting hepatitis C. According to the CDC, injection drug use is now the primary risk factor for new HCV infections.

Though an estimated 80% of new HCV infections occur among people who inject drugs (PWID), this population is systematically denied access to new curative therapies and science-based prevention strategies in discussions surrounding hepatitis C treatment access. It is critical to prioritize this population for screening, linkage, and treatment both to address the community’s healthcare needs and to halt the increase in new infections.

 

Hispanics and Latinos

Hispanics and Latinos have an overall HCV prevalence of 2.6%, have faster liver fibrosis progression rates, are more likely to be coinfected with HIV, and contract HCV at an earlier age. Latinos also have a higher HCV mortality rate. CDC data for the year 2011 shows the hepatitis C mortality rate per 100,000 people was 4 for Caucasians and 7.15 – nearly two times higher – for Latinos.

 

Native Americans

The prevalence of HCV in American Indian/Alaska Native (AI/AN) population is largely unknown. However, AI/AN have the highest rate of acute HCV infection than any other racial/ethnic group, the highest HCV-related mortality rate of any US racial/ethnic group. From 2009 through 2013, AI/AN HCV-related mortality rate increased by 23.2% (CDC). AI/AN also have a higher prevalence of liver disease than other racial/ethnic groups.

 

People Who Are Incarcerated and Returning Citizens

A disproportionate number of people with hepatitis C (HCV) in the U.S. are or have been inmates in jails and prisons. The prevalence of HCV is high among persons who are incarcerated, with studies estimating rates that range from 10% to more than 33%.

Since over 90% of individuals in jail or prison will be released back to the community in the future, addressing hepatitis C within correctional settings is an excellent opportunity to promote public health by increasing awareness, reducing transmission, and improving hepatitis-related outcomes, both during and after incarceration. 

Click here for a fact sheet on hepatitis C in prisons and jails.

 

NVHR Involvement and Events

Adult Vaccine Access Coalition (AVAC)

The Adult Vaccine Access Coalition focuses on raising awareness, improving access, and increasing utilization of vaccines among adults. While the hepatitis B vaccine has been successfully integrated into the childhood vaccination schedule, contributing to a 96% decline in the incidence of acute hepatitis B in children and adolescents, approximately 95% of new HBV infections occur among adults.

Despite Advisory Committee for Immunization Practices (ACIP) recommendations, vaccines have been consistently underutilized in the adult population and lag far behind the Healthy People 2020 goals for most commonly recommended vaccines, such as hepatitis B. Disparities are even greater among at-risk populations, including seniors and individuals with chronic illnesses.

In addition, the opioid epidemic has contributed to an increase in acute hepatitis B infection among young people who inject drugs (PWID). The Advisory Committee on Immunization Practices recommends that PWIDs get vaccinated against hepatitis B.

 

Coalition for Syringe Access (CSA)

NVHR is a member of the Coalition for Syringe Access (CSA), a national organization of stakeholders, including medical societies, policy and community groups, and individual programs working in communities to provide prevention and health care services related to syringe service programs and harm reduction.

NVHR also serves as a steering committee member of the CSA coalition. In this role, we work to ensure that viral hepatitis is included in discussions surrounding drug user health, harm reduction programs, syringe service programs, and prevention methods tied to the opioid epidemic.

Follow the Coalition for Syringe Access on Twitter to stay updated on issues related to syringe access, viral hepatitis, and drug user health.

 

Hepatitis Foundation International Summit

During Hepatitis Awareness Month in May of 2016, NVHR’s Executive Director, Ryan Clary, spoke at a Hepatitis Foundation International Summit focused on Hard to Reach, Hard to Treat Populations.

In his comments, Clary delivered strong remarks regarding hepatitis C treatment access restrictions, stating that, "While market competition has brought hepatitis C medication prices down, there hasn't been a significant parallel decrease in Medicaid restrictions, including for restrictions for stigmatized populations like people who inject drugs."

 

Hepatitis B Screening for High-Risk Communities

In July of 2016, the Centers for Medicare and Medicaid Services (CMS) has released a proposed decision memo for adding hepatitis B screening as a covered Medicare preventive service at no cost to Medicare beneficiaries who are at high risk as defined by the United States Preventive Services Task Force.

Adding hepatitis B screening as a covered Medicare preventive service would significantly improve efforts to identify people living with hepatitis B and link them to lifesaving care and treatment. NVHR also recommend that these comments include a request to expand coverage beyond the primary care setting. By limiting coverage to primary care, CMS would be creating barriers to hepatitis B screening in other vital health care settings, such as emergency departments. Similar restrictions have created significant challenges in hepatitis C screening and other covered preventive services.

This process is the result of advocacy by NVHR, the Association of Asian Pacific Community Health Organizations (AAPCHO), Hep B United, the Hepatitis B Foundation, and the National Task Force on Hepatitis B.

NVHR Documents

Stand with Mumia Abu-Jamal: Demand Hepatitis C Treatment Now  September 7, 2016
NVHR and a coalition of others living with hepatitis C, advocates, health educators and medical providers stood in solidarity with those demanding immediate hepatitis C (HCV) treatment for Mumia Abu-Jamal, as well as for all people living with HCV in the Pennsylvania prison system.

Medicare Program: End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program
As part of the Adult Vaccine Access Coalition (AVAC), NVHR signed on to this letter written to the Centers for Medicare and Medicaid Services regarding the ESRD Quality Incentive Program (ESRD QIP). Individuals with chronic kidney disease have higher incidence or severity of some vaccine preventable diseases, including hepatitis B and nd pneumococcal conjugate and pneumococcal polysaccharide due, to altered immunocompetence.

As part of AVAC, NVHR believes the ERSD QIP should include a focused, concerted effort to improve access and utilization of adult immunizations, particularly hepatitis B, as a means of improving the overall health of patients living with kidney disease.?

The Medical Case for Curing All Patients with Hepatitis C
With such powerful curative HCV treatment on the market, advocates and patients can envision a day where hepatitis C is eliminated in the United States. However, with many insurers limiting access to new direct-acting antivirals (DAAs) to only those patients with severe liver scarring, this fact sheet presents a medical argument for curing all people living with hepatitis C now.

The Kelly Report: Health Disparities In America
This report was compiled by Congresswoman Robin L. Kelly, of Illinois’ 2nd Congressional district, during her time as chair of the Congressional Black Caucus Health Braintrust. This report examines nationwide health disparities and lead policymakers and medical thought leaders in a meaningful direction in improving health outcomes in the United States.

This report featured an article by NVHR’s former Senior Policy Manager, Christine Rodriguez, entitled "A Silent Inequity: Hepatitis C in the African American Community." In this piece, Rodriguez emphasizes the disproportionate impact of hepatitis C on the African American community. The article includes several policy recommendations, including expanding hepatitis C testing and harm reduction efforts, and ensuring that correctional health systems are included and supported in implementing hepatitis C screening and preventive services.

NVHR & National LGBTQ Task Force Submit Comments to CDC
NVHR and the National LGBTQ Task Force submitted comments to the CDC regarding CDC’s Proposed Data Collection: "Prevent Hepatitis Transmission Among Persons Who Inject Drugs." Their recommendations include adding sexual orientation to demographics questions and adding street hormones to safe injection practices for LGBTQ youth.