Access to Hepatitis C Drugs Lacking for Native Populations

Hepatitis C affects a disproportionate number of American Indian and Alaskan Native people, more than any other racial or ethnic group in the country, and treatment efforts are being hampered by limited government funding, according to a recent journal article.

 

“The consequences of inadequate access to HCV treatment are visible in the continued disparity in morbidity and mortality in American Indian/Alaska Native people,” state the authors of the article published online May 26 in the Journal of the American Medical Association.  

 

Written by Jessica Leston of the HIV/HCV Clinical Program of the Northwest Portland Area Indian Health Board in Portland, OR, and Joe Finkbonner, the board’s executive director, the article is meant to summarize a “clear disparity with a clear solution regarding HCV mortality in Indian Country”, Leston said in an e-mail.

 

It is estimated that more than 3 million people in the county have hepatitis C, a bloodborne virus that if left untreated can severely damage the liver over time. Health officials have recommended widespread testing for the virus among certain populations, especially with the advent of new drugs that have higher cure rates and shorter treatment durations than medicines of the past.

 

There are an estimated 120,000 people who are positive for hepatitis C virus living on Indian reservations, according to the article. The AI/AN community is also hit harder by hepatitis C-related deaths, with a mortality rate of 12 deaths per 100,000 people, more than twice the national rate of 5 per 100,000, according to recent studies.

 

The AI/AN population receives much of its health care through the Indian Health Service (IHS), a government agency that serves the community in numerous states in the nation.  For the past four years, the IHS has worked to provide hepatitis C testing for people born between 1945 and 1965, increasing screening among the AI/AN population served by IHS nationwide from 7.9% to 32%, as of this time last year.

 

 

“With this fourfold increase in testing in just 3 years, IHS needs to prepare for the challenges associated with increased identification of persons living with HCV infection,” stated the authors.

 

The new therapies that use direct acting antiviral drugs may be considered cost effective but that does not necessarily mean they are affordable, noted the authors. Standing in the way of people in the AI/AN community in need of treatment are IHS budget constraints and treatment criteria that favors treating the sickest patients first, they said.

 

“Only a limited number of American Indian/Alaska Native patients belong to tribes that have notable incomes stemming from natural resource or gaming royalties,” the authors stated. “With 1 in 4 American Indian/Alaska Native people living below the poverty line and with an average household income of just higher than $30 000, paying even a small proportion of the out-of-pocket cost for this potentially life-saving medical treatment is not an option for most patients.”

 

The article points out that Medicaid and insurance companies attempting to contain costs have imposed restrictions on who gets treated for the virus. Eligibility in some cases requires that a patient have significant liver damage, such as stage 3 or stage 4 liver damage.

 

“These criteria present a quandary: earlier treatment can prevent advanced liver disease, but late-stage liver disease is needed to qualify for treatment,” stated the authors.  “For a clinician, explaining this circular logic to a patient can be frustrating for both parties.”

 

The authors noted that the IHS has not received extra funding to supplement the high costs of new hepatitis C drugs. They concluded that special congressionally approved funding may be required to give treatment access for IHS patients who “should be a federal priority to fulfill its obligations to tribal nations and American Indian/Alaska Native people.”