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Universal HCV screening is a pathway to eradication
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When we think about the possibility of universal screening, we can dance around, trying to dig out baby boomers or injection drug users, we can look at different risk factors or select populations, but I am not satisfied with that. We need to go for full blown eradication, and if we are going to do that, we must screen everyone and get those who test positive into treatment.
We are dealing with an epidemic that we can eliminate. So if we are going to think about eliminating this virus like we have done with smallpox, we should be serious about it. A good place to start is a public health approach. Namely, testing and treating. It is simple to say that everybody needs to be tested at least once for HCV, period.
The next step is to consider how we are going to treat everyone who tests positive. In the United States, we need to think outside the box and look at the ways other countries have approached the epidemic. Australia has shown us that it is possible to make a deal to pay for medications without paying on a per-unit basis. They pay the drug company a certain amount of money to provide the country with as much drug as they can use for a finite period. I characterize this as a win-win-win. The company makes money, the government saves money because it is a finite, predetermined amount, and of course, patients are cured. Patients are motivated to enter the system because of the time limit. This kind of creative thinking will give the U.S. a legitimate shot at eradication. If we continue with the piecemeal approach we have been using, we will continue to see new cases, and the cost will be unconstrained.
Next, we need to learn from the mistakes we made with baby boomers. Again, in a piecemeal fashion, providers are only so motivated to perform the test. And owing to competing priorities, testing was not universally performed. Also, there was no plan of action for referring patients who tested positive into care. Or, even if they were referred to care, the cost of therapy was prohibitive. “Boomer” screening was a good idea but, ultimately, a failed approach. So why would we want to keep doing that in different populations?
If I told you right now I had a cure for HIV that required only 12 weeks of treatment, there would be heavy motivation to test, treat and eradicate. I cannot understand why the same mindset has not been applied to HCV. One possibility is that there is a great deal of activism surrounding HIV and hardly any activism in HCV. HIV went mainstream. We need a motivated public to insist that HCV is a priority, and we, as providers, need to take part in that effort.
Where there’s a will, there’s most certainly a way. Let’s get it done.
Editor’s Note: A version of this article appeared in HCV Next.
- For more information:
- Michael S. Saag, MD, is associate dean for global health at the University of Alabama at Birmingham School of Medicine, director of the UAB Center for AIDS Research and a professor of medicine in the division of infectious diseases.
Disclosure: Saag reports no relevant financial disclosures.