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HCV/HIV Coinfection New $9 Milion Federal Funded Program
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to read more about HRSA's proposed Ryan White HIV/HCV program, see page 301
Budget Request
The FY 2017 Budget Request for the SPNS Program of $34.0 million, an increase of $9.0 million over FY 2016 Enacted, to support Hepatitis C Treatment in People Living with HIV. Hepatitis C virus (HCV) affects approximately 3.2 million people in the U.S., making it the most common chronic blood borne infection.264 Approximately 50 percent of those infected are not aware of their infection.265 Over time, chronic HCV can lead to liver failure, liver cancer and death. Among those with HIV, approximately one quarter is co-infected with HCV. People with HCV/ HIV co-infection have higher liver-related morbidity and mortality, even when their HIV infection is well-controlled.17 Chronic hepatitis C infection can be cured, and treating HCV leads to better health outcomes and is cost-effective.266 Several highly effective medications are available to treat and cure hepatitis C in people living with HIV (PLWH) with minimal side effects. Unlike previous treatments, the newer medications have been shown to be equally effective in curing HCV in those individuals that are co-infected with HIV.267 These new medications represent the culmination of major breakthroughs in drug development.
Despite advances in treatment, only a small percentage of HCV-infected patients have received treatment.health care systems that do not support treatment and follow-up of HCV also contribute. 268 The high cost of these newer treatments, which has limited access to treatment, has been at the forefront of discussions regarding why HCV treatment is not being more widely prescribed. Other barriers such as a lack of physicians trained and willing to treat HCV and health care systems that do not support treatment and follow-up of HCV also contribute. Poor patient uptake and poor patient adherence of HCV treatment is low in mono-infected patients, and is even lower among HCV/ HIV co-infected patients.
The Ryan White HIV/AIDS Program (RWHAP)269 has been at the forefront of HCV treatment among PLWH. However, given the changes in the health care environment and advances in treatment, additional work is needed to expand treatment of HCV among PLWH. The $9.0 million will be distributed among four RWHAP Part A and four Part B recipients as competitive grants. Each of the implementation sites will receive between $800,000 and $1.5 million, depending on epidemiology and demonstrated need to expand and provide treatment of HCV to PLWH.
Recipients will be selected based on demonstrating that they can reach populations that are at high risk for HCV infection, such as by age cohort (e.g., persons born between 1945-1965), and high risk behaviors such as injection drug use. Recipients will also need to have infrastructure established that can be scaled up for HCV testing and treatment activities quickly. The implementation sites will represent areas of high burden of HIV/HCV co-infection. Demonstrated successes from the project have a high probability of being generalizable to treatment strategies for mono-infected persons with HCV, since the health departments will develop local systems to treat hepatitis C using multiple resources.
Knowledge of prevention and treatment for the public health issue of HCV will be increased through education of providers on the hepatitis guidelines and the quality of health care will improve. By getting infected individuals appropriate treatment earlier in infection, health outcomes will improve as health care costs associated with HCV infection decrease. It can also be extrapolated from HIV care that treatment of HCV also prevents new HCV infections, which in turn decreases the overall public health burden. This project has the potential to increase the number of HIV/HCV co-infected patients who are successfully treated for HCV by 5 percent in one year, but with sustained implementation of the models, could increase to 25 percent over the subsequent 5 to 10 years.
An Evaluation and Technical Assistance Center will also be funded to educate providers nationally on HCV, including appropriate screening, care, and treatment of HCV infection among PLWH who are co-infected with HCV.
The funding request also includes costs associated with the grant review and award process, follow-up performance reviews, and information technology and other program support costs
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