Universal screening in Cherokee Nation aims to eliminate hepatitis C

Nearly half of the Cherokee Nation American Indian population received screening for hepatitis C and approximately one-quarter of those with the infection are cured, according to a press release from the World Indigenous People’s Conference on Viral Hepatitis in Anchorage, Alaska, which coincides with the International Day of the World’s Indigenous Peoples on Aug. 9.

“Because Cherokee Nation citizens, under a treaty right with the United States Government have access to medical care, tracking them and screening them is slightly easier than might be so for other U.S. populations,” Jorge Mera, MD, head of the Infectious Diseases at Cherokee Nation in Tahlequah, Oklahoma, said in the release.

According to Mera, Cherokee Nation’s HCV elimination program started in August 2015 following support from the CDC. Additionally, Gilead donated $1.5 million through its Gilead Foundation for screening kits and research. There are more than 350,000 Cherokee Nation tribal citizens worldwide with approximately 130,000 located in northeastern Oklahoma.

Mera and his team worked with the Indian Health Service to design their elimination program, which offers screenings to all citizens aged 20 to 69 years (about 80,000 people), rather than focus on the baby boomer generation alone.

To catch as many people as possible, Mera and colleagues extended the elimination program to offer screenings at dental clinics, to children of mothers who were unsure of their infection status at the time of childbirth, and to patients at emergency care with informed consent who did not opt out of screening.

Since the program started, about 46,000 people have received screening, 1,076 of whom tested positive for HCV antibodies. Of the 760 individuals with chronic HCV, 605 have begun treatment and 155 are awaiting tests or to begin treatment. Already, 400 people have completed treatment and have achieved cured status. Potentially, there are more cured individuals, as not all patients return after treatment for confirmation tests.

“We are trying to raise awareness among our citizens to prevent further cases,” Mera said in the release. “New treatments have few or no side effects and treatment is completed in just 12 weeks in most cases.” Regarding risk factors associated with HCV transmission, Mera said: “As well as the ongoing dangers of injecting drug use, another problem we may have is that much of the tattooing in Cherokee Nation does not always take place in state-licensed facilities, and it could be a contributor.”

Mera concluded that he is hopeful the upscale of opioid substitution programs in Oklahoma could support a decrease in HCV transmission as needle exchange programs are not currently legal in the state.

“We will apply for further agency grant funding to help train community health workers to test people who may never visit the doctor or dentist and educate our tribal citizens about why this elimination project is essential,” Mera said in the release. “This is similar to the way Navajo Nation American Indian tribe trained their community health workers to test and deliver care for HIV in their population.” – by Talitha Bennett

Reference: www.wipcvh2017.org