Hepatitis C virus (HCV) continues to cause high mortality, with the rate of HCV-related deaths among American Indian and Alaska Native (AI/AN) people more than double the national rate. However, there are reasons for optimism as we observe Hepatitis Awareness Month this year. AI/AN HCV mortality rates are dropping, in large part due to improved diagnosis and treatment. Plus, medications to cure this chronic disease are easier to access, and treatments are simple and have high cure rates. These factors create a scenario where more people can be treated locally in their Indian Health Service (IHS), tribal, or urban Indian health (I/T/U) clinic.

Further, HCV screening and treatment can be so effective that several Indigenous communitiesExit Disclaimer have their own HCV elimination programs. Globally, there is a goal to eliminate HCV by 2030, and the Viral Hepatitis National Strategic Plan provides a roadmap for doing so in the United States. Elimination programs could eventually stop the deaths caused by HCV, the nation’s leading cause of liver cancer and liver transplants.

“If more providers could treat hepatitis C, especially in rural and underserved areas, then more patients would be reached. The committee encouraged AASLD [Association for the Advancement of the Study of Liver Disease] and IDSA [Infectious Disease Society of America] to train and support primary care providers to manage viral hepatitis, expanding on existing collaborative training models.”
—A National Strategy for the Elimination of Hepatitis B and CExit Disclaimer, National Academies of Science, Engineering, and Medicine

Virtual Indian Country ECHOExit Disclaimer (Extensions of Community Health Outcomes) clinics, supported by the Minority HIV/AIDS Fund, IHS, and the Northwest Portland Area Indian Health Board, have expanded HCV services to clinics serving AI/AN people. The program has grown to five Hepatitis C ECHOs per month supporting Indian Country from a single monthly clinic in 2017. Since then, virtual ECHO clinics have supported 1,475 clinicians from 219 clinics serving AI/AN communities. Participating clinicians soon find that their knowledge, confidence, and ability to treat patients in-house increases. Bringing quality care directly to patients has reduced costs and has reduced patients’ need to travel for services. Patients get the care they need right in their community from clinicians they trust. In addition, a review of 65 regional health facilities in 2018Exit Disclaimer found that about half (29/65, 44.6%) participated in ECHO.  However, these ECHO sites accounted for 92.3% of all IHS HCV treatment medication orders.

Indian Country ECHO is proud to be part of the response and launch its first HCV Elimination ECHO, a series of virtual clinics dedicated to helping clinicians develop and implement community-tailored HCV elimination programs. To learn more, please visit https://www.indiancountryecho.org/program/hepatitis-c-elimination/Exit Disclaimer or email me at dstephens@npaihb.org