Burning the Bridge for Hepatitis C infections with Sterile Syringe Programs. Are you contributing to the Global Viral Hepatitis Elimination Plan?
Despite the availability of curative treatments for hepatitis C, acute HCV infections continue to be on the rise largely due to the opioid and injection drug use epidemics.
Health care agencies world-wide, including the Veterans Health Administration (VA), recognize that multiple factors are at play and that global elimination of both HIV and hepatitis C (HCV) will be largely depend on key issues that include access to treatment and access to prevention. These are not mutually exclusive – both must occur consistently and at a high rate if we are to achieve our National and Global HCV elimination strategy by 2030.
Syringe Services Programs (SSPs) are critical to global viral elimination for several reasons:
- Acute HCV is often silent making treatment an option only for those seeking testing/care
- Prevention is not possible by vaccination
- Most new acute HCV infections in the USA are reported in people who inject drugs (PWID)
Hence, in order to stop new infections, an important prevention strategy is utilizing sterile syringes with very open access to people who may not be engaged in health care.
The Illinois-based Danville VA is the first VA facility in the U.S. to implement an SSP. This program, started in 2017, was made possible by local and national leaders and required an understanding of common stigma that often accompanies underserved populations like PWID. Due to federal regulations, VA facilities cannot purchase syringes for exchange programs but can distribute them and/or link Veterans to community programs. To make this VA program possible, partnership and collaboration with a local Harm Reduction Center and the Illinois Department of Health was key. These partners paved the way and shared their experience and data about the efficacy for SSP. The collaboration provided insight about the complex patients and facility barriers that existed.
We know PWID don’t live in silos and often share their syringes placing entire communities at risk for viral epidemics. Such an outbreak occurred just 2.5 hours away from Danville in a small community of Scott County, Indiana. The HIV and HCV outbreak was the result of over 500 syringe sharing partners in a small community that did not offer SSP.
The CDC revealed the outbreak was precipitated by the introduction of a single case of HIV resulting in over 200 cases of HIV infection in whom over 67% also tested positive for HCV and more recently publicized information indicates that rapid response in testing and provision of an SSP may have averted this outbreak all together.
Today, the Danville VA provides comprehensive services to Veterans including general health care and vaccination, mental health care, inpatient and outpatient medication assisted therapy, overdose prevention therapy, condoms, and pre-exposure prophylaxis. The addition of SSP allows providers to cure hepatitis C while minimizing the potential for re-infection with HCV or acquisition of new HIV infection. This collaboration with local state programs brings us one step closer to global viral elimination by burning the bridge to the spread of new infections.
Additional reading from prior blogs:
- Profound economic and health consequences on Americans, including the increase in hepatitis C infections in the united States.
- Comprehensive syringe services programs (SSPs) have the proven ability to help combat the opioid crisis and prevent the spread of infectious disease linked to injection drug use.
- Nearly 30 years of research indicates that comprehensive SSPs are safe, effective, and cost-saving; do not increase illegal drug use or crime; and serve an important role in reducing transmission of viral hepatitis, HIV, and other infectious diseases. SSPs can serve as an entry point to recovery support services and overdose prevention and HHS is dedicated to informing communities about this critical public health intervention.
- Learning from other successful programs such as Australia which is on track to meet the 2030 Global elimination plan. http://cdafound.org/polaris/
Related pages and posts:
- The Important Role of Substance Use Disorder Treatment Providers in Ending the HCV and HIV Epidemics
- Substance Misuse, Infectious Disease, and the Powerful Potential of Syringe Service Programs
- VA has cured 100,000 Veterans of Hepatitis C
