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Hepatitis C Virus Treatment Strategies and Guidance from Washington DOH

Monday, September 17, 2018   (0 Comments)
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Hepatitis C Virus (HCV) Treatment Strategies and Guidance from the Washington State Department of Health


The Department of Health wants to ensure healthcare providers have the latest information, guidance, and resources to prevent and treat hepatitis C.  Over the next six months, DOH will share resources and information to help healthcare providers implement best practice recommendations to care for priority populations and build stigma and health disparity awareness.  Below is a breakdown of the latest best practices, clinical guidance, coverage information and resources for on-demand information and training. 

Recommended Best Practices for addressing Hepatitis C in Washington State
Healthcare providers play a critical role in ensuring people living with hepatitis C or at risk of infection, get the care they need and guidance they need. Please ensure that these recommended activities are put into practice by clinicians and your care team: 

  • Screen all persons born 1945-1965 at least once in their lifetime. 
  • Screen all persons with risk factors for HCV, all persons living with HIV and anyone originating from the former Soviet Union or Syria at their first medical visit. 
  • Screen all persons who are currently or who have ever injected drugs annually.
  • Follow up with antibody-positive patients in your practice to ensure they receive a confirmatory RNA test and are linked to care for treatment.
  • Implement systems to promote screening and referral for care. 
  • Integrate HCV treatment into your clinical practice.
  • Counsel HCV-positive persons on adherence for those receiving treatment, transmission prevention, and liver health. 
  • Counsel HCV-negative persons who may be at high risk of acquiring HCV about prevention strategies, such as safer drug use practices, linkages to care, treatment and recovery services.

Clinical Guidance for HCV Diagnosis and Treatment
All-oral direct-acting antiviral (DAA) medications, with unprecedented effectiveness and tolerability, are now the standard curative treatments for HCV. Due to changes in diagnosis and treatment technologies, the guidance changes often, so we suggest reviewing this resource regularly. 

The American Association for the Study of Liver Disease and the Infectious Diseases Society of America have developed HCV guidance that represents the best clinical practices for HCV prevention, testing, and management. Their guidance, Recommendations for Testing, Managing, and Treating Hepatitis C, is available at https://www.hcvguidelines.org

The Washington Medicaid Hepatitis C Policy provides detailed direction on approval protocols, preferred DAA products, provider requirements for treatment and care management, and medical necessity determination protocols. The latest update is available at https://www.hca.wa.gov/assets/billers-and-providers/WA-Apple-Health-HepatitisC-Clinical-Policy.pdf.

HCV Coverage and Financial Support Information
Direct Acting Antiretroviral (DAA) medication and clinical monitoring are covered by major insurance plans, Medicare and Washington Medicaid. Manufacturers offer additional support through patient assistance programs.  Initiating treatment can take time and require a lot of paperwork, consider partnering with a specialty pharmacy to help relieve the administrative burden. A specialty pharmacy specializes in medication management for complex conditions and managing specialty drugs with expertise in serving patients with hepatitis C and other chronic disease.

Resources and Training Opportunities for Clinicians
The University of Washington (UW) hosts an educational website for healthcare providers. 

  • The Hepatitis C Continuing Education Courses are free and include educational resources related to HCV diagnosis, monitoring, and management. Continuing Medical Education (CME) and Continuing Nursing Education (CNE) credits are available. More information is available at https://www.hepatitisc.uw.edu/

  • UW’s Project ECHO HCV mentors clinicians in underserved/rural areas in the treatment of HCV. Project ECHO provides primary care clinicians with access to: UW Medicine specialists in infectious disease, hepatology, and addiction medicine; brief updates on evidence-based strategies to treat HCV; Continuing Medical Education (CME) credits per hour of participation. More information is available at https://www.uwmedicine.org/referrals/telehealth-services/provider. (Please note that Project ECHO may currently be at capacity, so check with them for availability)

Stigma and Health Disparities Considerations
In recent years HCV has increased among people under the age of 40, largely associated with the opioid crisis and increases in people injecting drugs and sharing equipment. Active injection drug use is not a contraindication to HCV therapy. Treating and curing HCV among people who inject drugs is critical not only for their health, but for curbing ongoing transmission of the virus. Consider partnering with a syringe services program and substance use treatment service provider in your area for additional support. Program and contact information for syringe service programs is available at https://www.doh.wa.gov/Portals/1/Documents/5620/150-096-SyringeProgramsWA.pdf. Program and contact information for substance use treatment services is available at


Hepatitis C: Testing Recommendations, Risk factors, and Priority Populations

Between 58,000 and 75,000 are living with the hepatitis C virus (HCV) in Washington State, and an estimated 2,200 new infections of HCV occur within our state each year.  We have seen drastic increases in HCV among younger people, largely associated with the opioid crisis and increases in people who are injecting drugs and sharing drug use equipment. 

Below is a breakdown of the latest guidance on risk factors that should prompt annual and one-time testing, and resources for on-demand information and training.   




Resources for Clinical Training

University of Washington (UW) Free Hepatitis C continuing education courses for healthcare providers 
UW hosts an educational website for healthcare providers that includes free courses and educational resources related to HCV diagnosis, monitoring, and management of high risk and priority populations. More information on screening and diagnosis of hepatitis C is available at https://www.hepatitisc.uw.edu/go/screening-diagnosis.

National Viral Hepatitis Roundtable offers free resources for training primary providers and other healthcare workers about the importance of HCV screening and linkage to care in priority populations. More information is available at http://nvhr.org/content/provider-resources. 

Chronic Liver Disease Foundation provides several free resources including, but not limited to; Hepatology Centers of Educational Expertise (HCEE) which is a hepatologist-led working group dedicated to education healthcare professionals on the latest development in the management of chronic liver disease, live CME webcast meetings and an extensive clinical CME webcast library.  More information is available at http://www.chronicliverdisease.org/disease_focus/hcv.cfm?dstate=hcv&sec=wc.

Stigma and Health Disparity Considerations
Many people at risk for and living with hepatitis C report feelings of stigmatization and social isolation related to their diagnosis, including perceived and real experiences of discrimination in health services. Medical providers can help reduce this stigma and discrimination by taking an accurate and non-judgmental medical history,
including a history of substance use, and providing health education and counseling in a concise and engaging manner. For tools on how to do this, one helpful resource is a toolkit for medical providers about providing hepatitis C for people who inject drugs:  https://www.projectinform.org/pwidtoolkit/. 

Hepatitis C Treatment Among People Who Inject Drugs
Clinical recommendations have been updated emphasizing that recent and active [injection drug use] should not be seen as an absolute contraindication to HCV therapy from the American Association for the Study of Liver Diseases (AASLD)/Infectious Diseases Society of America (IDSA) hepatitis C treatment guidelines.  Additional Information is available at https://www.hcvguidelines.org/.




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