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Patient-centred models of hepatitis C treatment for people who inject
drugs (HERO Study): a multicentre, pragmatic randomised trial
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Download the PDF here
Download the PDF here
(HERO Study): a multicentre, pragmatic randomised trial
I designed Check Hep C & the Patient Navigator Program & termed this phrase in HCV, Jules Levin, NATAP
Published:December, 2022
Alain H Litwin, Paula J Lum, Lynn E Taylor, Shruti H Mehta, Judith I Tsui, Judith Feinberg, Arthur Y Kim, Brianna L Norton, Moonseong Heo, Julia Arnsten, Paul Meissner, Alison Karasz, M Diane Mckee, John W Ward, Nirah Johnson, Irene Pericot-Valverde, Linda Agyemang, Ellen S Stein, Aurielle Thomas, Courtney Borsuk, Kendra L Blalock, Samuel Wilkinson, Katherine Wagner, Jillian Roche, Cristina Murray-Krezan, Jessica Anderson, Vanessa Jacobsohn, Anne F Luetkemeyer, Oluwaseun Falade-Nwulia, Kimberly Page, on behalf of the HERO Study Group
I invented and designed Check Hep C 17 years ago and raised $2 mill in funding for NYC, and I designed & defined the Patient Navigator Program & coined that term for HCV. It was the first large citywide HCV screening, linkage & treatment project and set the new standard for future such programs. I participated in the HERO study as a team study member. HERO is proof IDUs can & should be treated for HCV, HCV is curable, and HCV could be eliminated in the USA relatively easily but only with complete comprehensive programs for IDUs providing appropriate services & can - screening, linkage, treatment. The White House Estimate $6-8 billion to do this but have yet to outline a plan, in their AASLD presentation they suggested they will request funding for a small demonstration project from Congress - that will delay Elimination years. We have waited many years for the federal commitment o eliminate HCV in the USA, it certainly is doable, if it were a cure for diabetes or heart disease or cancer you know it would happen, but this is for stigmatized IDUs so in that we have the barrier, the dilemma. there IS NO DOUNVT it would save lives & the White House estimates $49 Billion. Its the stigma of IDUs. Jules Levin
AASLD: Models to Eliminate HCV in the USA: A Multisite Randomized Pragmatic Trial of Patient-Centered Models of Hepatitis C Treatment for People Who Inject Drugs: The HERO Study - (11/28/22)
This is a great accomplishment, a great groundbreaking study conducted in the most difficult to treat HCV patient population using drugs regularly, unstable housing, with very variable adherence YET shows that this population can be treated & cured successfully. In HIV we retreat many times patients who fail therapy due to non adherence ye in the world of hepatitis some think pretreatment for HCV is not worthy. For the typical HIV+ patients HIV treatment over 30 years + care costs $500k per patient ! in HCV cure is 8-12 weeks short-term therapy for about $15,000 or less then healthcare costs are minimal after tat related to HCV unless they had cirrhosis then patient MUST return every 6 months FOREVER for MRI or ultrasound for HCC surveillance because despite cure due to having cirrhosis they remain at some risk.
Is there any doubt HCV Elimination is cst effective. At this AASLD the White House Team session presented healthcare cost savings of $15 Billion in short term & $49 bill over long term id we could launch & successful implement their proposed HCV Elimination Plan - which in fact besides the announcement that they want to do this they have not announced a plan, I suppose the do not yet have a plan, nor d they have funding, which they estimated at about $8 billion needed for an aprox. 5 year plan.
HCV is curable, the only virus tat is curable with short term safe, tolerable pill treatment that is INEXPENSIVE. The biggest barrier is the main patient population are Injection Drug Users, both young & old & those who formerly used an injection drug and their sex partners. This community is so stigmatized that its taken any federal authority this long to announce an Elimination attempt. Congress has for years underfunded this with the paltry amount of up to $39 mill as the latest. THIS IS AN INSULTINGLY LOW AMOUNT CONSIDERING HIV GETS BILLIONS YET HCV IS CURABLE.
Despite this recent new White House HCV Elimination announcement there remains no funding yet !There is no plan yet announced ! They have suggested a small demonstration project first to show Congress its doable, well that could take several years least.
We need a Ryan White Care Act like program for this proposed HCV Elimination Plan. This like in HIV would provide a framework for care, for sites, fir doctors, staff & screening & linkage programs and community connections - for a national project. You must have a uniform singly & well coordinated framework for this project.
Frankly, disappointing. When Obama announced they would look for an HV cure the NIH pounced on it and deduced gigantic funding & projects that persist to this day despite tat they have not found 1 drug or treatment that works. HCV DAA treatment WORKS, it cures HCV, its INEXPENSIVE - $15,000 per course of treatment - cost-effective - saves $15-49 billion in healthcare cars. YET WHERE IS THE PLAN, WHERE IS THE MONEY, show me the money !!!
There are many experts who could lend their top notch experience in developing the best models of care to this federal plan, I dont know that the White House team has yet to meet with them. This HERO Study investigator Alain Litwin was perhaps the earliest model developer in NYC's IDU community in the Bronx at a community clinic. I Jules Levin invented, designed and funded for $2 mill the Check Hep C program in NYC, the very first large scale city-wide HCV testing linkage & treatment. Stacey Trooskin in Philadelphia developed a successful city-wide model for IDUs. There are numerous others who cloud & should be able to lend their successes to a national HCV Elimination Program. We need a woking group BUT FIRST WE NEED REAL COMMITMENT & FUNDING from the White HouseTeam.
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