By Michaela Ramm | The Gazette | May 16, 2022

CEDAR RAPIDS — Linn County Public Health is now offering treatment for hepatitis C in its clinic, an unusual step for a county public health department in Iowa as local officials take on a larger role in harm reduction efforts.

Hepatitis C is an inflammatory liver disease, affecting at least 27,000 people in Iowa, caused by a virus, which is passed by contact with blood from someone who has the infection. For some, it’s a short-term illness, but the majority develop chronic infections.

Historically, chronic hepatitis C has been among baby boomers, or those born between 1945 and 1965, officials with the Iowa Department of Public Health said. Experts say that’s because there was no widespread screening of the nation’s blood supply before 1992, and because of recreational drug use in this age group from the 1960s to 1980s.

In 2020, baby boomers accounted for roughly half the Iowans diagnosed that year. However, in recent years, a growing number of new cases in Iowa has been detected in a younger demographic. State public health officials say cases of acute infection have increased every year in Iowa since 2009, and are found at the highest rates among those aged 20 to 39 years.

Injection drug use is the main risk factor for people in this age group, who are becoming infected with the virus by sharing needles or other equipment used to inject drugs.

Eighty-eight percent of those with confirmed chronic hepatitis C in 2021 reported a history of injection drug use, while the remaining 12 percent were baby boomers, according to a report from the Iowa Department of Public Health.

To address this growing concern, public health officials are expanding harm reduction efforts to better keep this population healthy — such as expanding access to hepatitis C testing and treatment options.

“We know there’s barriers for those individuals when seeking services,” said Heather Meador, clinical branch supervisor at Linn County Public Health. “We want them to know there’s a safe place for them to come where we can help them through their journey and help with hepatitis C testing and treatment.”

Linn County unique

The Linn County Public Health clinic is now offering hepatitis C treatment options to anyone, even those who live outside the county. Meader said not many local public health clinics have the capacity to offer that service, making Linn County one of the few — if not the only — public health departments in the state with this service.

Meador said the clinic will work with any insurer or patient assistant programs, since health insurance coverage can be a barrier for individuals seeking treatment.

Currently, Iowa Medicaid requires individuals to document three months of alcohol and substance use sobriety, a requirement that blocks Iowans who need treatment the most from receiving care, according to harm reduction activists at Harvard Law School and the National Viral Hepatitis Roundtable.

By offering treatment to anyone, Linn County’s goal is to keep those who use substances as healthy as possible so they’ll be able to seek treatment for substance use disorder when they’re ready, Meador said.

“We want to meet people where they’re at, to see if we can help them along their journey,” Meador said.

This comes as a new report from the U.S. Centers for Disease Control and Prevention show the number of people nationwide seeking hepatitis C treatment options declined between 2015 and 2020.

directory of providers treating viral hepatitis patients on the Iowa public health website lists 19 providers, not including two additional facilities in Nebraska and South Dakota.

The state does not have data on treatment, but spokeswoman Sarah Ekstrand did note the CDC report that highlighted barriers to treatment, including “the COVID-19 pandemic and payer policies related to treatment such as prior authorizations,” she said.

The report also noted certain treatment requirements — including sobriety requirements and restrictions on providers who can manage treatment — are major barriers to treatment in many state Medicaid programs.

In 2019, Iowa did remove the limit on hepatitis C treatment for Medicaid members with advanced liver disease. Previously, those in earlier stages of disease would not have treatment covered.

New cases rising

Federal and state officials are increasing hepatitis C screenings in an effort to identify more infections that may be going undetected nationwide. New CDC recommendations state all U.S. adults should receive hepatitis C screening at least once in their lifetime.

The publicly funded Integrated Testing Services program through the state provides free hepatitis C virus testing for certain populations at 12 clinical and outreach settings across the state.

A state report shows administered tests increased 41 percent in 2021 from 2020, but total screening numbers “have not yet returned to pre-pandemic levels.” Only positive tests from other test sites are reported to the state public health department.

Confirmed diagnoses of chronic hepatitis C have been increasing over the past 20 years in Iowa, rising 56 percent between 2000 and 2020. However, after new cases peaked at 1,697 individuals in 2015, the number of people diagnosed with chronic hepatitis C annually did decrease between 2015 and 2020, according to data from the Iowa Department of Public Health.

In 2020, 825 new cases were confirmed by the state, a 30 percent drop from the 1,173 individuals diagnosed with chronic hepatitis C in 2019.

As of Dec. 31, 2020, more than 27,000 Iowans diagnosed with chronic hepatitis C were reported to the state public health department. Public health officials say that total is likely higher, if estimates on the tens of thousands of undiagnosed cases in Iowa are accurate.

People with hepatitis C may not present any symptoms. One study from the National Institutes of Health published in 2020 found more than half the individuals diagnosed with chronic hepatitis C did not know they had the virus.