Scanner Will Help Start Hep C Treatment Faster

USDA grant will help support patients

An $80,000 piece of equipment could affect how quickly thousands of Kentucky and Tennessee patients can start treatment for a potentially deadly chronic bloodborne liver infection.

With a grant from the USDA, community health center Dayspring Health has purchased a FibroScan device to expedite treatment of patients with hepatitis C.

FibroScan used for diagnosis

The FibroScan uses ultrasound to diagnose hepatitis C and the extent of damage it’s already done to the liver, including scarring on the liver and the amount of buildup of fat in liver cells. Before Dayspring — which has clinics in Jellico and Clairfield and Williamsburg, Kentucky — purchased the device, patients near the Tennessee-Kentucky border would have had to drive to Knoxville or Lexington for a scan.

Without treatment, hepatitis C patients can develop liver cancer or lose liver function — and since upwards of 80% of infections have no symptoms, at least at first, quick diagnosis is crucial.

And that area of rural Appalachia has seen a marked increase in hepatitis C infection, in large part tied to the opioid epidemic: hepatitis C can be transmitted by sharing needles or straws.

Northern Kentucky alone has a hepatitis C rate more than 10 times the national average; cases tripled between 2011-2015.

So the new scanner “is critical,” said Dr. Geogy Thomas, chief medical officer for Dayspring. “Our whole idea is that we’re going to be able to reclaim futures.

“Too often, this population has been forgotten or pushed aside or just kicked down the road, because basically it’s a rural community, it’s a poor community, it’s a drug-using community. ... We’re going to bring first-class treatment to those who want it.”

The ‘silent killer’ affects old and young

Overall, the country’s rate of hepatitis C infection more than doubled between 2004 and 2014, with a 300 to 400% increase in people younger than 40, according to a 2018 report published by the American Journal of Public Health.

Tennessee Health Commissioner Lisa Piercey, MD, MBA, FAAP, said that in Tennessee alone, 150,000 individuals are living with chronic hep. C.

“Let me break that down for you,” Piercey said. “That’s 2% of all Tennesseans. That’s one in 50. You talk about making an impact on our state, this is certaintly one of those things.”

Thomas said “Baby Boomers” have a higher risk for hepatitis C because they might have received blood transfusions in the years before donated blood was routinely tested for the virus.

“But, really, the biggest, scariest group is young people,” he said.

Since hepatitis C is a bloodborne infection, most people, in theory, are susceptible to contracting the infection. Something as simple as sharing a razor or toothbrush with an infected spouse potentially could transmit it.

Though it’s not a sexually transmitted disease, contacting a sex partner’s blood - through genital cuts or menstruation, for example - could result in infection.

Opioid factor and symptoms

However, sharing needles when injecting drugs has driven the recent spikes in hepatitis C.

Injection drug use is now the most common risk factor for hepatitis C, and data indicates 28 percent of those who inject drugs are infected within a year.

“Once the virus is introduced into a network of persons who inject drugs, it can circulate quickly through the reuse of contaminated drug injection equipment — specifically, needles, syringes, cookers and filers,” the report said.

While the infection is often “silent” for many years, symptoms do arise after the virus causes enough damage to the liver according to the Mayo Clinic website.

Some of the symptoms include bleeding easily, bruising easily, fatigue, poor appetite, yellow discoloration of the skin and eyes (jaundice), dark-colored urine, itchy skin, fluid buildup in the abdomen (ascites), swelling in the legs, weight loss, confusion, drowsiness and slurred speech, and spider-like blood vessels on your skin.

More patients could be cured

Dayhealth started scanning patients’ livers back in June and with the new liver scanner at Dayspring Health, Thomas said individuals who might have not sought treatment before could be helped.

“If you’re a poor, young woman living in Jellico, Tennessee, or somewhere in Kentucky and you have to drive an hour away to get your liver scanned,” you may not go, Thomas said. “You can’t get these medicines that could potentially save your life without a FibroScan.”

Thomas said that individuals don’t have to necessarily be a primary patient at Dayspring Health. Primary physicians at other clinics can refer patients to Dayspring Health to be scanned.

New drugs have revolutionized the treatment of hepatitis C, with some averaging a 90% cure rate - but the medications are quite expensive.

Thomas said though costs have gone down, in part because of generic versions of medications coming out, treatments still run anywhere from $40,000 to $120,000.

Harvoni, a one-a-day pill with a 90% cure rate if taken as prescribed, is very effective at curing individuals but each pill is $1,125, with an eight-week treatment costing $63,000 and a 12-week treatment costing $94,500, according to Medical News Today website.

For some patients, Medicaid will help cover the costs of treatment. However, for those without insurance, they will fill out a patient assistance form which will cover it. Thomas said he works with patients to push down barriers like the cost, even reaching out to different drug companies to possibly find generic brands that are less expensive.

And total cure must have patient buyin, Thomas stressed: Even if cured by one of the new drugs, patients still could become infected again by a different strain of the virus.

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