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To reduce the burden of HCV, it will be important to expand harm reduction for people who inject drugs. One model comes from Australia, where high treatment uptake has reduced the prevalence of active infection in this population.

Hepatitis C affects >3 million people in the United States, and often leads to end-stage liver disease or death. In 2014, several new drugs to treat hepatitic C virus received US Food and Drug Administration approval, with remarkable cure rates exceeding 90%. Medicaid, however, is rationing these drugs, and other insurers have restricted coverage due to their exorbitant costs and the large size of the population in need. These access barriers and disparities have resulted in national patient advocacy mobilization, US congressional inquiry, and legal challenges. The US Department of Health and Human Services has been urged to intervene. We propose the establishment of a federal program, analogous to AIDS Drug Assistance Programs, to reduce access barriers and facilitate focused price negotiations. The federal government may further undertake a nonvoluntary acquisition of the pharmaceutical patents pursuant to federal statutory authority and principles of eminent domain. Projections indicate this proposal could lower costs by 90% and eliminate rationing.

ABSTRACT BACKGROUND Many of the five million Americans chronically infected with hepatitis C (HCV) are unaware of their infection and are not in care. OBJECTIVE We implemented and evaluated HCV screening and linkage-to-care interventions in a community setting. DESIGN We developed a comprehensive, community-based HCV screening and linkage-to-care program in a medically underserved neighborhood with high rates of HCV infection in Philadelphia, Pennsylvania. We provided patient navigation services to enroll uninsured patients in insurance programs, facilitate referrals from primary care physicians and link patients to an HCV infectious disease specialist with intention to treat and cure. PATIENTS Philadelphia residents were recruited through street outreach. MAIN MEASURES We measured anti-HCV seroprevalence and diagnosis, linkage and retention in care outcomes for chronically infected patients. KEY RESULTS We screened 1,301 participants for HCV; anti-HCV seroprevalence was 3.9 % and 2.8 % of all patients were chronically infected. Half of chronically infected patients were newly diagnosed; the remaining patients were aware of infection but not in care. We provided confirmatory RNA testing and results, assisted patients with attaining insurance and linked most chronically infected patients to a primary care provider. The biggest barrier to retaining patients in care was obtaining referrals for subspecialty providers; however, we obtained referrals for 64 % of chronically infected participants and have retained most in subspecialty HCV care. Several have commenced treatment. CONCLUSIONS Non-clinical screening programs with patient navigator services are an effective means to diagnose, link, retain and re-engage patients in HCV care. Eliminating referral requirements for subspecialty care might further enhance retention in care for patients chronically infected with HCV.

ObjectiveThe initiative was developed to address gaps in retention in HIV care.MethodsThe initiative consisted of small-group didactic sessions and faculty/participant discussions with HIV providers and external partners.ResultsWe delivered small-group educational sessions to 219 participants at 9 HIV clinics. The average relative gain in confidence at posttraining in regard to implementing measures to identify and reengage patients with care was 27% (  < .01) and at 30-day follow-up was 22% (  < .01). Intent-to-change practices at posttraining around identifying patients no longer attending clinic were observed, including intent to improve use of resources and increase collaboration with external organizations. There was a 58% increase (  < .01) in collaboration with external partners at follow-up.ConclusionThe initiative demonstrated that in-person, small-group education and strengthening linkages with external partners can improve HIV clinic staff awareness and help build relationships with community partners to reengage patients in HIV clinical services.

Chronic hepatitis C virus (HCV) infection may influence cytokine and insulin-like growth factor (IGF-1) levels, which could contribute to increased hepatic steatosis. We utilized MRI to compare three-dimensional volumetric liver fat fraction by chronic HCV status and evaluated associations between liver fat fraction and inflammatory cytokines and IGF-1. Participants with untreated, non-genotype 3 chronic HCV and participants without HCV were enrolled between 2019-2022 and underwent MRI to quantify three-dimensional volumetric liver fat fraction. Interleukin (IL)-6, IL-18, tumor necrosis factor (TNF)-α, and IGF-1 were also measured. Multivariable linear regression was used to determine associations between liver fat fraction, chronic HCV, and cytokine and IGF-1 levels. Among 54 participants with HCV and 54 without HCV, median volumetric liver fat fraction was 12.4% (IQR: 9.3, 18.0%) and 10.9% (IQR: 8.7, 13.3%), respectively. After adjustment for age, sex, and body mass index, mean liver fat fraction was 2.28% (95% CI: 0.55, 4.02%) higher in participants with HCV. HCV was associated with higher mean log TNF-α (0.11 [95% CI: 0.06, 0.16]) and IL-18 (0.14 [95% CI: 0.05, 0.24]), but lower mean log IGF-1 (-0.18 [95% CI: -0.26, -0.11]) when compared to those without HCV. IL-6, IL-18, TNF-α, and IGF-1 were not associated with liver fat fraction. Chronic HCV is associated with higher volumetric liver fat fraction by MRI. TNF-α and IL-18 levels were higher with chronic HCV but were not associated with liver fat fraction. Further research is needed to identify alternative mechanisms that potentiate liver fat deposition in chronic HCV.

Abstract Background Periodic surveillance of the hepatitis C virus (HCV) care cascade is important for tracking progress toward HCV elimination goals, identifying gaps in care, and prioritizing resource allocation. In the pre-direct-acting antiviral (DAA) era, it was estimated that 50% of HCV-infected individuals were diagnosed and that 16% had been prescribed interferon-based therapy. Since then, few studies utilizing nationally representative data from the DAA era have been conducted in the United States. Methods We performed a cross-sectional study to describe the HCV care cascade in the United States using the Optum de-identified Clinformatics® Data Mart Database to identify a nationally representative sample of commercially insured beneficiaries between January 1, 2014 and December 31, 2019. We estimated the number of HCV-viremic individuals in Optum based on national HCV prevalence estimates and determined the proportion who had: (1) recorded diagnosis of HCV infection, (2) recorded HCV diagnosis and underwent HCV RNA testing, (3) DAA treatment dispensed, and (4) assessment for cure. Results Among 120,311 individuals estimated to have HCV viremia in Optum during the study period, 109,233 (90.8%; 95% CI, 90.6%–91.0%) had a recorded diagnosis of HCV infection, 75,549 (62.8%; 95% CI, 62.5%–63.1%) had a recorded diagnosis of HCV infection and underwent HCV RNA testing, 41,102 (34.2%; 95% CI, 33.9%–34.4%) were dispensed DAA treatment, and 25,760 (21.4%; 95% CI, 21.2%–21.6%) were assessed for cure. Conclusions Gaps remain between the delivery of HCV-related care and national treatment goals among commercially insured adults. Efforts are needed to increase HCV treatment among people diagnosed with chronic HCV infection to achieve national elimination goals. Between January 2014 and 2019 in a commercially-insured population, the HCV care cascade shifted toward higher diagnosis, but only 34% of individuals estimated to have HCV viremia were dispensed direct-acting antiviral therapy. Gaps in HCV treatment remain that will make it difficult to achieve national HCV elimination goals.

In Philadelphia, 66% of new HIV infections are among African Americans and 2% of African Americans are living with HIV. The city of Philadelphia has among the largest numbers of faith institutions of any city in the country. Although faith-based institutions play an important role in the African American community, their response to the AIDS epidemic has historically been lacking. We convened 38 of Philadelphia's most influential African American faith leaders for in-depth interviews and focus groups examining the role of faith-based institutions in HIV prevention. Participants were asked to comment on barriers to engaging faith-based leaders in HIV prevention and were asked to provide normative recommendations for how African American faith institutions can enhance HIV/AIDS prevention and reduce racial disparities in HIV infection. Many faith leaders cited lack of knowledge about Philadelphia's racial disparities in HIV infection as a common reason for not previously engaging in HIV programs; others noted their congregations' existing HIV prevention and outreach programs and shared lessons learned. Barriers to engaging the faith community in HIV prevention included: concerns about tacitly endorsing extramarital sex by promoting condom use, lack of educational information appropriate for a faith-based audience, and fear of losing congregants and revenue as a result of discussing human sexuality and HIV/AIDS from the pulpit. However, many leaders expressed a moral imperative to respond to the AIDS epidemic, and believed clergy should play a greater role in HIV prevention. Many participants noted that controversy surrounding homosexuality has historically divided the faith community and prohibited an appropriate response to the epidemic; many expressed interest in balancing traditional theology with practical public health approaches to HIV prevention. Leaders suggested the faith community should: promote HIV testing, including during or after worship services and in clinical settings; integrate HIV/AIDS topics into health messaging and sermons; couch HIV/AIDS in social justice, human rights and public health language rather than in sexual risk behavior terms; embrace diverse approaches to HIV prevention in their houses of worship; conduct community outreach and host educational sessions for youth; and collaborate on a citywide, interfaith HIV testing and prevention campaign to combat stigma and raise awareness about the African American epidemic. Many African American faith-based leaders are poised to address racial disparities in HIV infection. HIV prevention campaigns should integrate leaders' recommendations for tailoring HIV prevention for a faith-based audience.

Abstract Recognizing the importance of timely guidance regarding the rapidly evolving field of hepatitis C management, the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) developed a web-based process for the expeditious formulation and dissemination of evidence-based recommendations. Launched in 2014, the hepatitis C virus (HCV) guidance website undergoes periodic updates as necessitated by availability of new therapeutic agents and/or research data. A major update was released electronically in September 2017, prompted primarily by approval of new direct-acting antiviral agents and expansion of the guidance's scope. This update summarizes the latest release of the HCV guidance and focuses on new or amended recommendations since the previous September 2015 print publication. The recommendations herein were developed by volunteer hepatology and infectious disease experts representing AASLD and IDSA and have been peer reviewed and approved by each society's governing board.

African Americans and Hispanics are disproportionately affected by the HIV/AIDS epidemic. Within the most heavily affected cities, a few neighborhoods account for a large share of new HIV infections. Addressing racial and economic disparities in HIV infection requires an implementation program and research agenda that assess the impact of HIV prevention interventions focused on increasing HIV testing, treatment, and retention in care in the most heavily affected neighborhoods in urban areas of the United States. Neighborhood-based implementation research should evaluate programs that focus on community mobilization, media campaigns, routine testing, linkage to and retention in care, and block-by-block outreach strategies.