The use of new, high-cost hepatitis C virus (HCV) drugs for California Department of Corrections and Rehabilitation (CDCR) prisoners has become a topic of debate. Prison health officials attribute high HCV prevalence in the CCDR to prisoners sharing needles for drugs and tattoos. More than 15,000 CDCR inmates have HCV, and 400 are receiving HCV medications. Only the more advanced cases get the newer, more expensive medications Boceprevir or Telaprevir, according to Dr. John Zweifler, deputy medical executive of central area field operations for California Correctional Health Care Services.
Zweifler also participates on the hepatitis C oversight committee that added Boceprevir and Telaprevir to the approved treatment list. Although Zweifler stated that the use of Boceprevir and Telaprevir can improve the cure rate from 35 to 70 percent, treating 50 inmates with the new drugs will increase CDCR’s medication cost by $2.5 million. CDCR policy aligns with American Association for the Study of Liver Diseases’ HCV treatment recommendations.
Opponents of the expensive treatment argue that prisoners should not receive high-cost medications that are not available to workers whose insurance does not cover the new drugs. Jon Coupal, of the Howard Jarvis Taxpayers Association, questioned whether the cost of treatment would be wasted if an inmate became re-infected while in jail.
However, John Sousa, a former drug user and prisoner who now works as a certified counselor at the C.O.R.E. Medical Clinic in Sacramento, agreed with Zweifler that it made financial sense to treat the prisoners, most of whom would have been eligible for HCV treatment before incarceration. Untreated HCV can lead to cirrhosis and liver cancer, which incur costly treatment. Zweifler stated that a prisoner who becomes re-infected would have to wait one year for a second round of treatment. May 19 was National Hepatitis Test Day.
The National Health Service (NHS) Confederation has issued new regulations designed to guide NHS employers and staff of European Union (EU) nations in the safe use and disposal of sharp medical devices. The regulations—which apply to all public and private employers, employees, and contractors in the EU healthcare sector—took effect May 11.
Even if medical staff do not acquire infection from an unintentional needle stick, “sharps injuries” cause “stress and psychological trauma” for staff and can result in work restrictions and lifestyle changes. Sharps injuries also can result in transmission of HIV or hepatitis. The Health Protection Agency reported that sharps injuries comprised 17 percent of healthcare workers’ injuries. Occupational exposure accounted for 17 HCV cases between 1996 and 2009.
Elisabetta Zanon, director of the NHS European Office, stated that employers’ organizations, the NHS European Office, the Health and Safety Executive, and trade unions collaborated closely to develop workable, sensible regulations. The rules address training and employee information and aim to minimize harm and prevent injuries in the field through the safe use and disposal of sharps.
The full regulations, “Guide to the Proposed Safety, Health, and Welfare at Work (Prevention of Sharps Injuries in the Healthcare Sector) Regulations, 2013,” are available at http://www.hsa.ie/eng/Your_Industry/Healthcare_Sector/Biological_Agents_/Sharps_/Directive_on_Sharps_/guide_to_the_proposed_regulations.pdf.
The Hanover Parish AIDS Association (HPAA) in Jamaica recently organized an in-school youth workshop for more than 20 students from Rusea’s High School and Rhodes Hall High School. The workshop covered basic facts about HIV, sexually transmitted infections (STIs), peer pressure, and abstinence. According to Sandina Williams, HPAA president, the workshop’s purpose was to discuss HIV and STI prevention and to educate students about the consequences of early sexual activity. She said that HPAA planned to hold additional workshops for other schools and to launch a program for at-risk youth in the parish.
Researchers from Yale University concluded that researchers need to put forth greater effort to screen high-risk individuals to find those coinfected with HIV and hepatitis C virus (HCV). Dr. Jamie Morano of the Yale School of Medicine Department of Infectious Diseases and colleagues reported on a study using data from health screenings by the Yale Community Health Care Van, a mobile medical clinic run by the university.
Of 8,300 people screened from 2003 to 2011, 8 percent had HIV infection, 10 percent had HCV infection, and approximately 26 percent of individuals with HCV were coinfected with HIV. CDC has estimated that 3.4 million to 4.9 million in the United States have HCV infection; they based this estimate on figures from the National Health and Nutrition Examination Survey, which is comprised of household interviews, physical examinations, and tests of serum samples. Dr. Frederick Altice, professor of medicine and epidemiology, and Morano contend that CDC’s numbers and those of similar surveys miss two of the most at-risk populations–the homeless and the incarcerated. They noted that the Yale study questioned individuals about past or present homelessness and incarceration. The authors stated that to find these individuals, researchers have to be creative and proactive and visit the areas where these populations congregate, as they do not readily go to health clinics or volunteer personal information.
The researchers agreed with CDC recommendation that all baby boomers be screened for hepatitis C, but they suggested that screening also should focus on behavioral risk factors. They believed that people who use intravenous drugs, men who have sex with men, and those who did not graduate from high school were most likely to be coinfected with HIV and HCV.
Raul Pino, health director for Hartford, Conn., agreed that aggressive screening was necessary. He commented that many HCV-infected people were unaware of their status. He added that in the past seven months, the mobile healthcare van and the Central Area Health Education Center regularly conducted screenings in different neighborhoods. The south end of the city showed a high concentration of people with HCV, which he suggested was linked to the use of intravenous drugs in those areas in the 1980s and 1990s.
The full report, “The Burgeoning HIV/HCV Syndemic in the Urban Northeast: HCV, HIV, and HIV/HCV Coinfection in an Urban Setting,” was published online in the journal PLoS ONE (2013; 8(5): e64321. doi:10.1371/journal.pone.0064321).
In 1995, Dr. Patricia Sulak, an obstetrician/gynecologist at Scott & White Hospital and professor at Texas A&M Medical School, was involved with Travis Middle School’s parent teacher organization in Temple, Texas, when the school superintendent asked her to find a suitable sex education curriculum. Sulak reviewed several sex education curricula and, as a parent and physician, found most were outdated, inaccurate, and unacceptable. Sulak talked to her Scott & White Hospital colleagues about collaborating to write a new curriculum.
Sulak declared, “After reviewing all the literature and problems of kids having sex, it’s obvious that they need to be waiting." The revised curriculum provides adolescents with medical facts and encourages them to delay the onset of sex. Sulak emphasized that it is best “for them to delay until they meet that one person they are going to spend the rest of their life with." However, she cautioned that if teens were going to be sexually active, they needed to see a healthcare professional to reduce their risk of getting an STD or becoming pregnant.
The Temple school board approved the Scott & White curriculum and began using it in their schools in 1996. Several other school districts have now adopted it as well. The seventh edition of Scott & White Wellness and Sexual Health was released in 2011. The program is geared toward students in grades six through 12, with a curriculum covering CDC’s six youth risk behaviors. The curriculum emphasizes the risky behaviors of sexual activity, avoiding drugs, bullying, gangs, and even suicide. The 2-week course provides valuable information, but some have questioned the lack of guidance during the remaining 50 weeks of the year. Sulak stressed that it was important for students to take their work sheets home to review with their parents what they learned in school. The teachers continually tell students that their parents are their safety net.
Sulak noted that the teen pregnancy rate has continued to decrease, both nationally and in Texas. CDC has documented that genital herpes has decreased in US teenagers. Sulak stated that they would like to think that this curriculum is a part of the solution by incorporating sex education into Bell County area schools and beyond, but also said it could be due to other things that people were doing as well. She urged the medical profession, communities, and schools to work together to promote healthy behavior.
Oregon’s Northeast United Soccer Club and The Portland Barefoot are working together to present the 2013 Portland Barefoot 3 x 3 Tournament & World Soccer Festival June 9 at Concordia University. The project started with Dr. Gordon Johnson, a Beaumont-Wilshire neighborhood physician. Johnson was at a world HIV conference when he first learned about the Grassroots Soccer program to raise HIV awareness in Africa. He organized the first Portland tournament four years ago and raised $2,500 with 60 players. This year, with 450 players and an estimated 1,000 spectators, Johnson hopes to raise $20,000. The volunteer-run soccer tournament aims to bring attention to HIV awareness worldwide.
A group of teens from Cañon City High School in Cañon City, Colo., are working to share facts and information about sex with other teens as The Cañon City Teen Advisors. The group, which is sponsored by the Cañon City Pregnancy Center, speaks to any church or school group that invites them, talking about sex and STDs and offering support and encouragement to those who need it. For more information on the group, visit www.canoncitypregnancycenter.com/cms2/index.php?page=teen-advisors.
On May 19, in Landsdale, Penn., individuals gathered inside the Lansdale United Methodist Church to participate in a free hepatitis C screening held from 1:00 to 8:00 p.m. in honor of National Hepatitis Testing Day. The event primarily targeted the North Pennsylvania area’s growing Egyptian population. Egypt has the highest rate of hepatitis C globally and many immigrants have recently settled in the area, according to Sandra Khalil, founder and president of the nonprofit healthcare organization CrossLink Medical Resources. The organization coordinated the event, which expected to screen 200 individuals from the Egyptian community.
According to Colorado’s Boulder Daily Camera newspaper, Boulder County AIDS Project supporters, volunteers, and staff members recently commemorated more than 150 local men and women who have died from AIDS. On May 19, the Interfaith AIDS Coalition of Boulder County and the Boulder County AIDS Project sponsored a walk that included an opportunity for memorial speeches and student readings of the names of those who had died.
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