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NECHV Vice President of Human Services Presents in National Viral Hepatitis Roundtable Webinar

Hepatitis C (HCV), a chronic viral infection that can cause serious liver conditions, affects approximately 3.5 million people in the United States. People with HCV may not realize they are infected because the virus damages the liver slowly over time, often without causing any symptoms. Left untreated, HCV can result in liver disease, cirrhosis, and liver cancer. The Veteran population is especially vulnerable to HCV infection; Veterans are three times more likely than the general population to have the virus, and Veterans born between 1945 and 1965 are five times more likely than other Veterans to have chronic HCV.

Vietnam Veterans are particularly at risk as a result of the injuries they sustained during combat that required blood transfusions; HCV testing was not perfected until 1992, leaving transfusion supplies open to contamination. Other risk factors for HCV are current or past use of intravenous drugs, having body piercings or tattoos, or being infected with HIV.

Luckily, screening for HCV is a simple blood test that provides results in as little as 20 minutes, and in recent years, great strides have been made in the treatment of HCV. Most people with HCV can be cured by taking medication that clears the virus from the bloodstream in 12-24 weeks. Treatment is recommended for all people with chronic HCV infection.

Because of the greater risk of HCV infection in the Veteran population, special efforts have been made to reach them for screening and treatment. These efforts have been largely successful, but there remain Veterans who are difficult to engage in care due to various barriers, including homelessness, substance use disorders, and other mental health challenges.

The National Viral Hepatitis Roundtable, a coalition of community-based, advocacy and grassroots groups, healthcare providers, health departments, and other government and industry partners working to eliminate hepatitis B and C in the United States, hosted a webinar that highlighted the ways different organizations address barriers that prevent Veterans from achieving an HCV cure. The NECHV’s Vice President of Human Services, Lena Asmar, MSW, LICSW, and Geren Stone, MD, of the Boston Health Care for the Homeless Program joined the webinar to discuss their success treating HCV in Veterans experiencing homelessness.

Within the last year, the NECHV and BHCHP have collaborated to launch an HCV treatment program, based on the successful results of a larger BHCHP program treating HCV in individuals experiencing homelessness. HCV treatment is offered to Veterans at the NECHV through BHCHP’s full service clinic on site. BHCHP and the NECHV designed the program to ensure that the barriers to entering, maintaining, and completing treatment are as low as possible: Veterans experiencing homelessness, actively using substances, or with other mental health conditions are eligible for treatment. BHCHP works closely with the NECHV case managers and therapists to support Veterans in completing HCV treatment, focusing not only on medical challenges, but also on the social factors that may impact a patient’s ability to take their HCV medication as directed, such as having stable housing.

The program, though small, has been highly successful so far. 100% of Veterans who completed treatment through the NECHV and BHCHP program are considered cured of HCV. There are Veterans still undergoing treatment, and others who are preparing to begin treatment. There have been zero instances of reinfection, due to the harm reduction framework practiced by the NECHV case managers and therapists, which seeks to minimize the harms associated with active substance use.

Asmar and Stone stressed the importance of meeting Veterans where they are and not excluding Veterans experiencing homelessness or struggling with substance use disorders from receiving treatment for HCV. They also credited the ongoing communication and collaboration among providers in both organizations for the program’s early success.

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