A multipronged approach built around screening, education, community outreach, and expanded access to care is critical to reducing the prevalence of hepatitis C in the African-American community.
A multipronged approach is critical to reducing the prevalence of hepatitis C, which is approaching crisis stage among African Americans, according to a gastroenterologist who spoke Wednesday during a webinar sponsored by the National Black Leadership Commission on AIDS, Inc.
“Especially within the African American community, we have to screen, we have to link to care and we have to make use of our community organizations,” said Joan A. Culpepper-Morgan, MD, chief of gastroenterology at Harlem Hospital Center in New York City.
Hepatitis C virus (HCV) is a global disease that affects 2% to 3% of the world’s population with a prevalence that ranges from 1% to 10% among countries, said Culpepper-Morgan. In the United States, it is highest among African Americans, who are twice as likely to have the disease.
According to data from the National Health and Nutrition Examination Survey (NHANES), about 1% of the general population has HCV, compared to 2% among African Americans. However, in small urban studies around the country, prevalence of the disease among African Americans was found to be much higher, ranging from 19% to 29%, so the NHANES data may be an underestimation, said Culpepper-Morgan.
“The prevalence in African Americans is very likely to be more than 10 percent,” said Culpepper-Morgan.
“These are alarming numbers,” she said. “I do think that these are numbers that make us characterize prevalence of hepatitis C in the African American community and in particular the urban (community) as being of crisis proportions.”
Hepatitis C, which is spread through contact with contaminated blood, can severely damage the liver over time and lead to cirrhosis or liver cancer. It is the leading cause of liver transplants in the US.
Linking patients to treatment for HCV has been problematic because many people don’t know they are infected or those who know they have the disease fear or avoid treatment for various reasons, including cost and access to care, noted Culpepper-Morgan. Also, people who inject drugs or did in the past may fear stigmatization by coming forward, or worry that being treated with the traditional interferon injections could jeopardize their sobriety.
Culpepper-Morgan advises primary doctors to educate patients about the dangers of HCV as well as advances in drug treatments that work faster and have fewer serious side effects than traditional treatment regimens.
“If you don’t ask, (patients) won’t know,” she said. “I think a good idea is - we know about colon cancer screening - screen the colon and the liver together of those patients in your practice.”
Treatment eligibility is another major barrier to effective treatment that places many of the drugs “out of safe reach” for African Americans who are more likely to be anemic from chronic diseases, more likely to be diabetic and more likely to have renal failure. Poor control of comorbidities decreases treatment eligibility, noted Culpepper-Morgan.
“So we have to encourage our patients to get all of their diseases treated and all of their diseases managed, to manage their blood pressure, to manage their hypertension, their diabetes, their renal failure,” she said, “all of the above, so that they can more successfully engage in treatment of their hepatitis C.”
Community organizations are crucial to support patients and help them overcome barriers to access and treatment for HCV, said Culpepper-Morgan. “Don’t reinvent the wheel,” she said and encouraged health care workers to seek support for their patients from a HIV infrastructure that has been in existence for decades.