Hepatitis C virus appears to strike South Texas Hispanics disproportionately, and some persons are not diagnosed until the liver-harming infection is in its late stages. Baby boomers born between 1945 and 1965 are at heightened risk, statistics show.
A hepatitis screening program is being implemented by UT Medicine San Antonio and the University Health System based on new guidelines from the U.S. Centers for Disease Control and Prevention (CDC) to test all baby boomers for this infection. The CDC estimates that this new screening program can find 800,000 baby boomers nationally who do not know that they have this infection.
Barbara J. Turner, M.D., M.S.Ed., M.A., M.A.C.P., of UT Medicine, and Roberto Villarreal, M.D., M.P.H., of the University Health System, lead the screening implementation program that is funded by a $200,000 CDC grant. UT Medicine is the clinical practice of the School of Medicine at the UT Health Science Center San Antonio. Dr. Turner is professor in the School of Medicine and director of the Research to Advance Community Health (REACH) Center, a collaboration of the Health Science Center, the University Health System and The University of Texas School of Public Health. Dr. Villarreal is vice president of community initiatives and translational research for the University Health System.
“We can significantly reduce the serious long-term consequences of hepatitis C, such as liver failure and liver cancer, if we test every baby boomer at least once for this infection,” Dr. Turner said. “In our program, we are developing the methods to test all baby boomers who are admitted to University Hospital and then link them to long-term care following the new screening recommendations issued by the CDC.”
The CDC’s guidelines are based on evidence that screening baby boomers for the infection can avert complications. Infected persons can protect their liver from more damage by being immunized against other damaging viruses and cutting down on alcohol use. Most importantly, for many infected persons six months to one year of medications against hepatitis C can cure the disease.
“In the last three or four years, the advent of more effective combination antiviral therapy has changed the outlook of people who are infected,” Dr. Villarreal said.
Pilot analyses identified more than 6,000 baby boomers who are hospitalized annually at University Hospital, which is the flagship facility of University Health System and a primary teaching hospital of the Health Science Center. Of these, more than 400 individuals (7 percent) have a recorded hepatitis C diagnosis. “We predict that an equivalent proportion of admissions will be identified as having undiagnosed hepatitis C infection, based on our prior study in another urban hospital,” Dr. Turner said. She came to San Antonio from the University of Pennsylvania’s Perelman School of Medicine in Philadelphia, where her team studied a majority African-American population.
The hepatitis C intervention program will use an electronic medical record and involve physicians, nurses and a case manager to determine how many patients are being tested for hepatitis C and systematically identify others who need this care. The team is also developing a mobile app educational program in English and Spanish for patients to access on mobile tablets or computers. Co-investigators Barbara Taylor, M.D., M.S.C.E., assistant professor of medicine and an infectious diseases specialist, and Joshua Hanson, M.D., M.P.H., assistant professor of medicine and a hospitalist, are collaborating on all aspects of implementation.
“At least 3 million persons in the U.S. have hepatitis C infection, and we want to be in the forefront of getting these individuals into care to protect them from the dire consequences of this infection,” Dr. Villarreal said. “We want to prevent a very costly disease that causes complications and can cause deaths.”
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