A 2012 initiative that Cherokee Nation Health Services (CNHS) in Oklahoma launched to enhance hepatitis C management has yielded significant, positive results among the American Indian population.
When Jorge Mera, MD, was hired as an infectious-disease physician by CNHS in 2012, he was tasked with establishing a clinic specializing in the management of chronic hepatitis C virus infection. That was a major undertaking. According to a 2015 report from the CDC, American Indians and Alaska Natives are 50 percent more likely than whites to be infected and almost three times as likely to die from hepatitis C.
After studying the high rate of infection in the American Indian population, Dr. Mera was determined to find ways to expand screening and, ultimately, improve patient outcomes.
“When I started, I ran into a backlog of 262 patients with [hepatitis C],” he says. “And that was the start. After the first year of evaluating all these patients and also estimating what would be the actual amount of patients in the area who had hepatitis C, the numbers grew pretty big. We thought we better do something a little bit more structural and organized to tackle this problem.”
Collaborating with Indian Health Service, CNHS began by launching a screening program that involved the implementation of EHR reminders. The reminders encouraged healthcare providers to target individuals born between 1945 and 1965 for hepatitis C screening, which is in line with expanded screening recommended by the CDC and the U.S. Preventive Services Task Force in 2012 and 2013, respectively.
“Medical providers are required to screen for a bunch of things ... and they have 15 or 20 minutes to see a patient,” Dr. Mera says. “We just implemented a tool so the provider wouldn’t have to worry about remembering [to screen for hepatitis C].”
That effort, along with educational programs for healthcare providers and patients coordinated with the Oklahoma State Department of Health and collaborations with the CDC, Oklahoma University and the University of New Mexico, proved to be a powerful combination. According to the CDC, first-time hepatitis C testing increased fivefold among patients using CNHS services between 2012 and 2015. During a 33-month period, among 92,012 individuals who have had at least one encounter with CNHS, the number of people screened for HCV for the first time climbed from 3,337 to 16,772.
Once patients were diagnosed, Dr. Mera’s group launched intensive treatment plans, administering antiviral medications — options that are better tolerated than interferon therapies previously used to treat hepatitis C. As part of the CNHS pilot program, 58 percent of patients with active HCV infection were treated with an antiviral, and 90 percent of those treated were cured.
“What we have now are multiple, different, equally efficacious regimens which are all oral and which have minimal side effects ...,” says David Bernstein, MD, Vice Chair of Medicine for Clinical Trials and Professor of Medicine at Hofstra Northwell School of Medicine in New York, who was not involved in the CNHS study. “You can really just treat and cure.”
Dr. Mera looks forward to the implementation of similar programs in other health systems, both to identify and treat hepatitis C and to eliminate the stigma surrounding the disease.