Doctors in the emergency department at UAB Hospital have identified
2,436 patients with the liver disease hepatitis C since they began
widespread testing in 2013, including an alarming number of young
injection drug users.
Hepatitis C is a viral liver disease that is usually spread by contact with the blood of an infected person. The virus attacks the liver and can cause inflammation, scarring and cancer. Some patients with untreated hepatitis C could require liver transplants. In 2013, pharmaceutical companies introduced drugs that eliminate the disease in a majority of patients.
Soon after UAB began screening, doctors noticed that patients identified as high-risk were testing positive almost four times more often than the national average, said Dr. James Galbraith, a professor in UAB's department of emergency medicine.
Rates were even higher among uninsured patients and those on Medicaid.
"What that points to is a lack of prior preventative primary care," he said. "These patients were not being offered screening previously. We're identifying them now, and now there is a cure."
When testing began in 2013, doctors targeted Baby Boomers, patients born between 1945 and 1965, who might have been exposed to the disease through blood transfusions and organ transplants. In September 2015, the testing expanded to include all patients between the ages of 18 and 75, Galbraith said.
Infection rates among younger patients have been much higher than Galbraith expected. About 12 percent of younger white patients tested in the emergency department came back positive for hepatitis C, he said. Only about 2 percent of black patients born after 1965 test positive.
The high rate of hepatitis C among younger white patients could be tied to increases in the use of opioids and methamphetamine, Galbraith said. Younger drug users may share needles and other drug paraphernalia that can spread the infection.
"I expected the prevalence for hepatitis C to be higher amongst the younger white patients rather than the younger black patients, and that's owing to what we know about the trends in uses of injection drugs, whether it's heroin or methamphetamine," Galbraith said.
The program has identified so many cases of hepatitis C that the hospital is now struggling to match those patients with providers and treatment, highly effective medications that can cost more than $100,000 for a full three-month course.
"The total number of people we were identifying was exceeding the capacity of any one health system to treat all of them in an efficient manner," Galbraith said.
The hospital has a three-person team to call patients who have tested positive for hepatitis C and help connect them with resources. Many of the patients who test positive have no doctor to turn to once they are discharged from the emergency room, Galbraith said.
"The biggest barrier to care that we've found is lack of access to primary care," Galbraith said.
Doctors at UAB have started a network called Active-C to provide testing and treatment across the state for hepatitis C. Doctors also need to help reduce the stigma around the disease so at-risk patients seek out testing, Galbraith said.
Galbraith said emergency departments in other hospitals could catch a lot of hepatitis cases if they start screening all patients, especially among individuals without regular medical care. Hospitals treat many patients who don't have access to primary care, and who might not otherwise be tested until they develop symptoms and liver damage.
"We've been successful in getting patients treated," he said. "Certainly more success in those with commercial insurance. But we also have uninsured individuals who have gone through the steps of our program, subsequently been linked to a primary care physician and to one of our treatment prescribers and who have been cured of hepatitis C."
Hepatitis C is a viral liver disease that is usually spread by contact with the blood of an infected person. The virus attacks the liver and can cause inflammation, scarring and cancer. Some patients with untreated hepatitis C could require liver transplants. In 2013, pharmaceutical companies introduced drugs that eliminate the disease in a majority of patients.
Soon after UAB began screening, doctors noticed that patients identified as high-risk were testing positive almost four times more often than the national average, said Dr. James Galbraith, a professor in UAB's department of emergency medicine.
Rates were even higher among uninsured patients and those on Medicaid.
"What that points to is a lack of prior preventative primary care," he said. "These patients were not being offered screening previously. We're identifying them now, and now there is a cure."
When testing began in 2013, doctors targeted Baby Boomers, patients born between 1945 and 1965, who might have been exposed to the disease through blood transfusions and organ transplants. In September 2015, the testing expanded to include all patients between the ages of 18 and 75, Galbraith said.
Infection rates among younger patients have been much higher than Galbraith expected. About 12 percent of younger white patients tested in the emergency department came back positive for hepatitis C, he said. Only about 2 percent of black patients born after 1965 test positive.
The high rate of hepatitis C among younger white patients could be tied to increases in the use of opioids and methamphetamine, Galbraith said. Younger drug users may share needles and other drug paraphernalia that can spread the infection.
"I expected the prevalence for hepatitis C to be higher amongst the younger white patients rather than the younger black patients, and that's owing to what we know about the trends in uses of injection drugs, whether it's heroin or methamphetamine," Galbraith said.
The program has identified so many cases of hepatitis C that the hospital is now struggling to match those patients with providers and treatment, highly effective medications that can cost more than $100,000 for a full three-month course.
"The total number of people we were identifying was exceeding the capacity of any one health system to treat all of them in an efficient manner," Galbraith said.
The hospital has a three-person team to call patients who have tested positive for hepatitis C and help connect them with resources. Many of the patients who test positive have no doctor to turn to once they are discharged from the emergency room, Galbraith said.
"The biggest barrier to care that we've found is lack of access to primary care," Galbraith said.
Doctors at UAB have started a network called Active-C to provide testing and treatment across the state for hepatitis C. Doctors also need to help reduce the stigma around the disease so at-risk patients seek out testing, Galbraith said.
Galbraith said emergency departments in other hospitals could catch a lot of hepatitis cases if they start screening all patients, especially among individuals without regular medical care. Hospitals treat many patients who don't have access to primary care, and who might not otherwise be tested until they develop symptoms and liver damage.
"We've been successful in getting patients treated," he said. "Certainly more success in those with commercial insurance. But we also have uninsured individuals who have gone through the steps of our program, subsequently been linked to a primary care physician and to one of our treatment prescribers and who have been cured of hepatitis C."
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