Dr. Doug White is on a hunt to save lives.
Specifically the lives of millions of Americans infected with Hepatitis-C Virus (HCV), a leading cause of end-stage liver disease. Most people living with HCV are unaware they are infected because they don’t experience any symptoms.
Five years ago treatment options for people with the HCV, were limited and complicated. Today the majority of persons infected with HCV can be treated.
“There are now antiviral meds that can cure about 95% of people who test positive for HCV. Our next step is identifying those who are infected.” said White, M.D., faculty member and emergency room physician at Alameda Health System-Highland Hospital. People who take the antiviral medication can be cured within a matter of months.
The advances are particularly noteworthy today…World Hepatitis Day.
“I think about HCV prevention all the time. Every day is World Hepatitis Day in the Highland Emergency Department (ED),” White said. “My world is the patients of Alameda Health System and I want them all to live full healthy lives.”
The opioid epidemic in the US has led to an increase in HCV incidence. Injection drug users have the highest prevalence of any group. Alameda County has the fifth highest rate of newly reported HCV cases in California.
Baby boomers account for 75% of people infected with HCV. Prior to 1991, blood collected from donation centers was not tested for HCV and HCV can lie dormant in the body for decades.
“Hepatitis C virus screening has long been considered impractical for EDs, but advances in testing technology, the development of new therapies, and improvements in reimbursement for screening have created new opportunities to implement screening in the ED setting,” said White.
In 2014, White received a grant from Gilead Sciences through their FOCUS Program. The grant supports developing novel protocols to integrate HCV screening into the ED, as well as performing clinical research related to HCV testing. The Highland ED was one of the first and continues to be one of the largest, ED-based HCV screening programs in the nation. If a patient in the ED will have blood drawn they will automatically be screened for HCV if they have not been screened within the past year. With this system almost 17,000 ED patients are screened annually and about 1,000 test positive for HCV.
“I’m really excited our new electronic health record system. It will allow us to be more collaborative as an organization and I am hoping to implement a universal screening policy at the system level, so screening is routinely performed for all patients and not just those seeking emergency care. This way we can identify those in our patient population with undiagnosed HCV infection and link them to curative treatment,” said White.
Because treatment has been simplified, there has been a local movement spearheaded by Kathleen Clanon, M.D., AHS physician and medical director of Alameda County Health Care Services Agency, to train primary care physicians within the local network of federally qualified health care centers. In addition to the HCV clinic at Highland, White’s team can now refer many HCV-infected patients to their primary care physician to receive treatment.
“There is more work to be done but I am very optimistic. We have learned a lot about how to integrate screening as a routine part of health care and we are critically evaluating the outcomes of our program and identifying ways to make it better,” said White.