viernes, 9 de mayo de 2014

Annals of Internal Medicine | Breaking the Silence on Viral HepatitisBreaking the Silence on Viral Hepatitis

Annals of Internal Medicine | Breaking the Silence on Viral HepatitisBreaking the Silence on Viral Hepatitis

CDC Hepatitis Updates: Breaking the Silence on Viral Hepatitis, two MMWRs

Viral Hepatitis Updates from CDC
Breaking the Silence on Viral Hepatitis
Assistant Secretary for Health Dr. Howard Koh and Deputy Assistant Secretary for Health Dr. Ronald Valdiserri co-authored a“Ideas and Opinions”piece for the Annals of Internal Medicine. Their commentary, “Breaking the Silence on Viral Hepatitis,” raises awareness of viral hepatitis and reflects on recent accomplishments in the national response to viral hepatitis, reviews important scientific and policy advances that are propelling progress, and discusses how the updated Viral Hepatitis Action Plan can serve as a framework for continued medical, public health, and community action.

MMWR: Expanding Primary Care Capacity to Treat Hepatitis C Virus Infection Through an Evidence-Based Care Model — Arizona and Utah, 2012–2014 Hepatitis C virus (HCV) infection is the leading reason for liver transplantation and a common cause of hepatocellular carcinoma, the most rapidly increasing cause of cancer-related deaths in the U.S. Of the approximately 3 million persons living with HCV infection in the U.S., an estimated 38% are linked to care, 11% are treated, and 6% achieve cure. Recent development of highly effective and well-tolerated medications to treat chronic HCV infection shows promise in curbing rising HCV-related morbidity and mortality, with the potential to cure >90% of patients. Lack of provider expertise in HCV treatment and limited access to specialists are well-documented barriers to HCV treatment. In Sept. 2012, CDC funded programs in Utah and Arizona to improve access to primary care providers with the capacity to manage and treat HCV infection. Both programs were modeled on the Extension for Community Healthcare Outcomes (Project ECHO), developed by the University of New Mexico's Health Sciences Center to build primary care capacity to treat diseases among rural, underserved populations through videoconferencing and case-based learning in "teleECHO" clinics. In both states, Project ECHO was successfully implemented, training 66 primary care clinicians, predominantly from rural settings. Nearly all (93%) of the clinicians had no prior experience in care and treatment of HCV infection. In both states combined, 129 (46%) of HCV-infected patients seen in teleECHO clinics received antiviral treatment, more than doubling the proportion of patients expected to receive treatment. These findings demonstrate Project ECHO's ability to expand primary care capacity to treat HCV infection, notably among underserved populations.

MMWR: Early Identification and Linkage to Care of Persons with Chronic Hepatitis B Virus Infection - Three U.S. Sites, 2012–2014
In the U.S., an estimated 0.8–1.4 million persons are living with chronic hepatitis B virus (HBV) infection. Among these persons, as many as 70% were born in countries of Asia, Africa, or other regions where HBV is moderately or highly endemic. HBV-associated cirrhosis and liver cancer are major health problems for these populations. CDC recommends HBsAg testing for all persons born in these areas and linkage to medical care and preventive services for those infected. In 2012, CDC awarded funds to nine sites to implement this recommendation. This report describes programs at three sites. During Oct. 2012–March 2014, the three sites tested 4,727 persons; 310 (6.6%) were HBsAg-positive. Among the HBsAg-positive persons, 94% were informed of their results, 90% were counseled, 86% were referred for care, and 66% attended their scheduled first medical visit. These projects demonstrate that community-based programs can identify infected persons among populations with a high prevalence of HBV infection and refer HBsAg-positive persons for care. Individualized efforts to assist patients with accessing and receiving health-care services ("patient navigation services") can increase the number of persons who follow up on referrals and receive recommended care.

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