Leading Viral Hepatitis Research and Advocacy Groups Launch Hep ElimiNATION, the First Project to Assess the Readiness of U.S. Jurisdictions to Eliminate Viral Hepatitis by 2030

The partnership will serve as a guide for all 50 states, Washington, DC, and Puerto Rico to develop comprehensive viral hepatitis elimination strategies.

News Release from Hep ElimiNATION, January 11, 2022

WASHINGTON, D.C. (January 11, 2022) – The O’Neill Institute for National and Global Health Law at Georgetown University Law Center (O’Neill Institute), the National Viral Hepatitis Roundtable (NVHR), and the Center for Health Law and Policy Innovation at Harvard Law School (CHLPI) today launched Hep ElimiNATION, a partnership to study viral hepatitis elimination efforts across the United States. Hep ElimiNATION is the country’s first comprehensive analysis of the policy landscape and programmatic strategies aimed at viral hepatitis elimination in the 50 states, Washington, DC, and Puerto Rico.

Hep ElimiNATION assigns a letter grade to all 52 jurisdictions based on elements of their current capacity to eliminate viral hepatitis by 2030 and in alignment with the HHS Viral Hepatitis National Strategic Plan, including:

• State viral hepatitis elimination plan development;
• Harm reduction laws and policies;
• Budget allocations;
• Improving viral hepatitis prevention, treatment and outcomes;
• Reducing viral hepatitis-related disparities and health inequities;
• Improving viral hepatitis surveillance and data usage; and
• Achieving integrated, coordinated efforts that address the viral hepatitis epidemics among all partners and stakeholders.

“Hep ElimiNATION is built on the important understanding that eliminating viral hepatitis by 2030, an ambitious goal set by the World Health Organization, requires a collective effort by federal and state policymakers, public health agencies, advocacy partners, community-based organizations, and those with lived experience,” said Sonia Canzater, JD, MPH, Associate Director at the O’Neill Institute. “Thanks to the work of our public health servants, including the viral hepatitis coordinators across the country working on prevention strategies, much work is already being done to make hepatitis elimination a reality. With an even greater look at the gaps and opportunity areas in each state’s viral hepatitis elimination capacity, Hep ElimiNATION can further guide policy and programmatic decisions to bring an end to viral hepatitis, a condition that impacts millions of Americans every day.”

Over 5 million Americans today are living with chronic hepatitis B and/or chronic hepatitis C, which can cause severe liver disease, liver cancer, and death. Tools to prevent, test for, and treat viral hepatitis exist, including vaccinations against hepatitis A virus (HAV) and hepatitis B virus (HBV), and highly effective treatment for hepatitis C virus (HCV). Yet the United States is losing ground on the fight against viral hepatitis overall. New infections have spiked due to the ongoing opioid overdose epidemic; only 25% of adults are currently vaccinated against HBV; and treatment levels for hepatitis C have disturbingly declined between 2014 and 2020, according to recently published data from the Centers for Disease Control and Prevention (CDC). Viral hepatitis disproportionately impacts communities of color, people who use drugs, immigrants, people who are incarcerated, and others who have historically faced inequities in access to healthcare. 

Based on a grading scale developed in consultation with more than 40 stakeholders, including advocates, clinicians, government partners, and people who have lived experience with viral hepatitis, Hep ElimiNATION is an advocacy tool to bring awareness to policymakers, public health agencies, and communities about a broad range of key considerations for elimination.

“Centering the voices of people with lived experience is critical to addressing the barriers that so many face in access to prevention, testing, and treatment for viral hepatitis,” said Adrienne Simmons, PharmD, MS, Director of Programs at NVHR. “Hep ElimiNATION will allow those with lived experience and other advocates to gain a better understanding of their state’s current capacity to eliminate viral hepatitis, and follow up with actionable recommendations and strategies to develop comprehensive and fully-funded elimination plans.”

“Viral hepatitis elimination requires investment in harm reduction strategies that lead to better outcomes for the most vulnerable populations, including people who inject drugs (PWID), who currently make up 80% of new HCV infections,” said Daniel Raymond, Director of Policy at NVHR. “Hep ElimiNATION recognizes the importance of harm reduction in elimination, and looks at jurisdictions’ capacity to screen, treat, and provide linkage to care for this community’s needs. We cannot end the hepatitis epidemic without providing full attention to the needs of PWID.”

Several states have published elimination plans since the beginning of 2019 to address critical issues that impact a state’s ability to tackle viral hepatitis, including legality of syringe service programs; budget allocations specifically marked for viral hepatitis elimination; training and educational programs; access to treatment for state Medicaid beneficiaries; and attention to disparities and health inequities, among other important pieces.

Beyond comprehensive elimination plans, jurisdictions across the country are increasing their efforts to eliminate barriers to treatment access, particularly for Medicaid recipients who are disproportionately impacted by the viral hepatitis epidemic. States are removing burdensome barriers to treatment, including restrictions based on liver damage, sobriety, and provider requirements. As of January 2022, eleven states have eliminated prior authorizations for hepatitis C treatment entirely.

“We are glad to see that an increasing number of jurisdictions are removing significant barriers to hepatitis C treatment access for Medicaid beneficiaries,” said Robert Greenwald, JD, Faculty Director of CHLPI. “Incorporating the findings of the Hepatitis C: State of Medicaid Access project, which evaluates treatment access in each state’s Medicaid program, Hep ElimiNATION takes into consideration the needs of Medicaid recipients and those who have long been subject to health inequity – a necessary consideration to achieve viral hepatitis elimination.”

Following today’s initial grade release, there will be a 90-day comment period when the public can submit requests for amendment, and any score modifications resulting from the comment period will be reflected in an update scheduled for June 2022. The scoring rubric for Hep ElimiNATION will be evaluated annually to ensure that it is responsive to the evolving elimination landscape and reflects the most current strategic needs. State scores will also be updated annually, and Hep ElimiNATION will continually monitor nationwide elimination efforts.

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HAWAII CAPACITY RUBRIC

TOTAL GRADE: B   36 / 55 POINTS

I. STATE VIRAL HEPATITIS ELIMINATION PLAN DEVELOPMENT

Hawaii has successfully created a viral hepatitis plan, it has been made available to the public, and people with lived/living experience were extensively involved in its development. The state has not committed to publish progress reports for its plan on an annual basis.

II. HARM REDUCTION LAWS

Although SSPs are legal, the state should consider expanding its syringe exchange laws from a 1-for-1 exchange to a needs-based exchange. A needs-based SSP policy would broaden the efficacy of these programs to reduce transmission of hepatitis, HIV, and other diseases.

III. BUDGET ALLOCATION

No funds have been allocated to implement the state’s strategies, but viral hepatitis is mentioned in the state’s budget as well as the state corrections budget.

IV. IMPROVING VIRAL HEPATITIS PREVENTION, TREATMENT, AND OUTCOMES

The state should include in its elimination plan strategies to conduct universal, opt-out HCV testing at intake to state corrections, and offer DAA treatment for HCV to all persons with a confirmed HCV diagnosis held in state corrections in accordance with tAASLD/IDSA treatment guidelines.

The state should also expand HCV treatment access for Medicaid beneficiaries by removing sobriety and prescriber requirements.

There are supports provided for targeted interventions across the state as well as an enduring collaborative network that is state led but also includes people with lived/living experience.

V. IMPROVING VIRAL HEPATITIS SURVEILLANCE AND DATA USAGE

Updated epidemiological data on HAV, HBV, and HCV was not located on the state department of health or Hep Free Hawaii sites.

read … Full Report

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