Seventeen American states had high rates of Hepatitis C in 2015 because they lacked laws and Medicaid policies to prevent drug users from developing the disease, and obtaining treatment once they did, according to a U.S. government report.
Those who inject drugs are the segment of the population most susceptible to the disease, also known as HCV, many studies have shown. A key reason they are prone to it is that many share contaminated needles with other users.
The report connecting public policy to the high levels of HCV in the 17 states is entitled “State HCV Incidence and Policies Related to HCV Preventive and Treatment Services for Persons Who Inject Drugs — United States, 2015–2016.” It was published in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
The report was based on information from the U.S. Census Bureau and the National Notifiable Diseases Surveillance System.
Because injected drug users account for most of the 17 states’ new HCV cases, their leaders need to tailor public policy to focus on this population, the report contended. But those efforts have been spotty so far.
The United States had about 33,900 new HCV cases in 2015, experts estimated.
Seven of the 17 states in the U.S. government study had an infection rate more than twice the national average. The rates in the other 10 also substantially exceeded the average.
Some states have passed laws aimed at reducing drug users’ HCV rate. A key focus is prevention: allowing pharmacies to sell syringes to the public, for example.
States’ health laws differ, however, so not all of the 17 states have passed legislation focusing on reducing drug users’ HCV risk.
West Virginia, a state with a high HCV rate, has yet to pass comprehensive laws aimed at reducing HCV among drug users, for example. But Kentucky and Massachusetts, which also have high rates, have done so — perhaps in response to the rise in HCV cases.
Medicaid is a national health insurance program that covers people with low incomes. But each state sets its own rules for administering the program to its residents.
That means state Medicaid policies can also facilitate or hinder drug users’ access to HCV prevention and treatment, the report said.
The cost of treating HCV has declined in recent years, which has helped make prevention and treatment better. But the burden to Medicaid of preventing and treating HCV remains high.
Twenty-four states had policies in 2015 that discouraged drug users from obtaining HCV treatment through Medicaid, the report said. One restriction was a requirement that, to obtain treatment, those wanting it had to be drug-free for a certain period.
In contrast, 16 states had policies requiring a person only to have screening and counseling to obtain HCV treatment through Medicaid.
States can tailor public policy to their “unique needs to serve as part of a comprehensive strategy for reducing HCV transmission through increased access to preventive services, including safe injection equipment and HCV treatment,” the report said.
“It is important for policy makers and public health officials to work together to understand the various needs of particular populations to prevent HCV transmission and disease,” it concluded.
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