Lessons Learned about Barriers to Hepatitis C Testing: Implications for Policy

Abstract

Despite primary prevention efforts to educate the public about hepatitis C, the most prevalent blood-borne human disease in the world today, most Americans remain unaware of their infection status. Widespread screening programs established to identify those at risk have been slow to emerge and difficult to implement, especially when compared to the nation's rapid response to the HIV/AIDS epidemic. Analysis of screening and testing practices among nurses and other clinicians within the Veterans Affairs Administration (VA), the site of the most comprehensive hepatitis C virus outreach program to date, reveals numerous barriers to reaching at-risk veterans. It is worthwhile to examine the VA experience for lessons in how to identify other Americans at risk, particularly those without access to primary care in well-funded, organized systems of care.

Therapeutic Discourse Among Nurses and Physicians in Controlled Clinical Trials

“…The silent progression of the illness, its associated stigma, and the lack of HCV screening in primary care settings all play a role in limiting the number of patients who find their way into HCV care and treatment. 6 Current standards of care involve combination therapy of pegylated interferon and ribavirin. With this combination, HCV eradication is achieved in up to 63% of patients, depending upon HCV genotype and other factors such as adherence to treatment.…”

Breaking the Silence Surrounding Hepatitis C by Promoting Self-Efficacy: Hepatitis C Public Service Announcements

“…were infected, four times the number infected with HIV" (Wong, McQuillan, Hutchison, & Poynard, 2000, p. 1562. Despite the high infection rates, diagnosis and treatment are still limited (CDC, 2006;Instone, Gilbert, & Mueller, 2003;Wong et al, 2000). Yet, there is a startling lack of awareness about HCV among individuals who might have contracted the virus, which has the potential for decreased overall personal health, increased transmission rates, and the expenditure of millions of dollars in health care costs (Buffington et al, 2001;CDC, 2006;Parini, 2001;Wong et al, 2000).…”

Illness Trajectory, the Diagnostic Discovery of Hepatitis C Disease, and “The Accidental Tourist”

“…In 200 1 , CDC launched a campaign to increase public awareness of HCV and to urge health care providers to check for the virus in persons at risk for infection. Although it is too early to determine the effects of nationwide education and screening efforts on HCV identification and treatment, an HCV testing initiative launched by the VA Medical System met with mixed results (Instone, Gilbert, and Mueller, 2003).Perhaps because HCV identification has only recently become part of the public health agenda in the U.S., little scholarly attention has been given to the social process…”