Michael Ninburg and Sue Birch: A public-private partnership to eliminate hepatitis C in Washington is a model for other states

By Michael Ninburg and Sue Birch

If COVID-19 has taught us anything, it is that data, resources and strategies must be shared to effectively protect patients and vulnerable citizens from public health threats. Here in Washington, those principles are the backbone of an effective public-private partnership to eliminate the devastating effects of the hepatitis C virus (HCV).

Washington’s innovative approach to eliminate HCV is changing lives and is a model for other states to customize to work toward the same goal. Just ask Christina D. Alexander, who received affordable and effective treatment through a Suboxone clinic here in Washington. “Now I am Hep C free, married, and going on one year clean. I urge people who are in active addiction treatment to please get tested and give themselves a chance.”

About 60,000 people in Washington are living with HCV, a serious but curable disease that attacks and damages the liver. If HCV is left untreated, it can lead to long-term illness, liver cancer and premature death. Nearly 600 Washingtonians die from HCV-related causes each year – with a disproportionate impact on minorities, underserved communities, baby boomers and people who have injected drugs. But this doesn’t have to be the reality.

Medications are available that can cure HCV with a once-daily pill in as little as eight to 12 weeks. Nine out of 10 people who receive highly effective treatment are cured, are less likely to develop liver cancer or long-term liver complications, and are not able to spread HCV to others.

Screening and treatment for HCV can also significantly reduce long-term health complications for patients, which can in turn reduce costs for both the patient and the state.

In 2019, Washington launched an innovative public-private partnership that brought the Washington State Health Care Authority (HCA), Washington State Department of Health, drug manufacturer AbbVie, and community leaders together to coordinate HCV elimination efforts.

The partnership enables all involved stakeholders to work in sync to test more people for HCV, break down barriers to treatment and care, and expand access to affordable and effective antiviral medications.

More HCV patients in Washington are now consistently seeing providers and receiving effective treatment, in a testament to the strong partnership developed with AbbVie.

Among the components of the partnership, HCA and AbbVie have launched an elimination bus tour that brings testing services directly to high-risk HCV populations across the state. Last year the bus tour visited Seattle, Spokane, and Olympia before the COVID-19 pandemic hit.

Today, the collaborative work to eliminate HCV is more critical than ever before in the face of the growing opioid use epidemic, which has been compounded by COVID-19.

The recent increases in hepatitis C in the U.S. have been driven largely by injection drug use as a result of the opioid crisis, creating what experts call a syndemic, or symbiotic public health crises.

Washington state saw a 21% increase in overdose deaths between May 2019 and May 2020, emphasizing the need for comprehensive care that addresses the syndemic.

In fact, more clinicians in Washington are treating patients through this lens. There is growing understanding of the link between opioid misuse and HCV transmission and the effectiveness of co-locating HCV treatment locations with treatment for opioid use disorder (OUD).

More often, addiction medicine physicians in Washington are providing treatment and care to patients for OUD and HCV simultaneously; and DOH has expanded the use of syringe service programs around the state.

Despite the challenges that patients have faced to maintain effective treatment and care during COVID-19, declines in HCV treatment rates due to the pandemic have been less severe in Washington than other states.

More work lies ahead to eliminate HCV in Washington, but we hope other states look to us for inspiration and answers in their own elimination efforts.

Across states lines, the principles to eliminate HCV remain the same: educate, test, treat and cure – starting with our most vulnerable neighbors.

The Washington partnership demonstrates that buy-in between dedicated public and private partners can help us eliminate this deadly disease.

Michael Ninburg is the executive director of the Seattle-based Hepatitis Education Project (HEP). Sue Birch is the director of the Washington State Health Care Authority (HCA).