Implementing TLC was a key component of Aaron Fleischauer’s presentation at UNC’s Friday Center on Monday, May 1. But he wasn’t talking about the acronym’s most common definition of tender love and care. He was referring to the test, link and cure strategy for decreasing the rates of hepatitis C virus (HCV).
Fleischauer, PhD, MSPH, is the career epidemiology field officer for the Centers for Disease Control and Prevention (CDC) assigned to the North Carolina Division of Public Health. He was one of several speakers who addressed the crowd of 455 health providers from around the state gathered for the annual HIV update conference sponsored by the UNC Institute for Global Health and Infectious Diseases, the UNC Eshelman School of Pharmacy and the Greensboro Area Health Education Center (AHEC). The meeting is the largest training for HIV providers in the state.
“The majority of our attendees serve the HIV community,” said Tina Latham, assistant director of regional education for the Greensboro AHEC. “Participants can choose from two tracks. One is for clinicians – physicians, pharmacists and nurses. The second track is designed for people who provide mental health, allied health or social services.”
This was the first year the conference included presentations on addiction and injection drug use, Latham said. Fleischauer’s presentation on HCV detailed how injection drug use is fueling an increase in HCV incidences.
“We are dealing with two HCV epidemics – the historic and the emerging,” Fleischauer said. “The historic HCV epidemic focuses on the Baby Boomer generation of people born from 1945-1965 who may have had an organ transplant or blood transfusion prior to the 1980s when we started testing for HCV. These are people living with chronic hepatitis. The emerging epidemic is associated with injection drug use. This is a younger group of people who are usually white and live in rural areas.”
In the United States, 5.7 million people are living with hepatitis B or C virus, Fleischauer said. He said 150,000 people in NC are living with HCV, but he believes that estimate is low, especially since Wilmington was recently named the number one county in the nation for injection drug use. In addition to hepatitis, injection drug users are at risk for contracting HIV. Fleischauer said legislative support of more syringe service programs is one way to prevent a spike in infectious diseases similar to the 142 cases of HIV in Scott County, Indiana, in 2015.
“Last year, the NC General Assembly approved a needle exchange program,” Fleischauer said. “More than one million free needles have been distributed.”
TLC also outlines ways to decrease the number of HCV cases. High-risk populations, including Baby Boomers, people living with HIV and injection drug users, should be tested at least annually for HCV. Anyone who tests positive should be connected with medical care as well as mental health, substance abuse and social services if appropriate. Since HCV is curable, treatment should be offered to those living with HCV to improve their health and prevent onward transmission, Fleischauer said.
Helping clinicians determine which HCV treatment to prescribe was the focus of another session. Presenters Heidi Swygard, MD, MPH, and Lisa Fletcher, PharmD, determine treatment plans for patients in UNC’s Infectious Diseases Clinic. They presented four case studies, coaching participants on what questions to ask patients to prescribe the correct medication.
“You need to keep in mind what other medications your patient is taking, their liver enzyme levels and any insurance restrictions,” Swygard cautioned. “Medicaid will only pay for one round of hepatitis C treatment. You need to ask your patient if he or she is ready to commit to what can be 12 weeks of therapy.”
UNC ID Clinic physician’s assistant Anh Eichholz and family nurse practitioner Brittany Alexander both attended the session, working together to solve the case studies. Eichholz said she appreciates the annual clinical update in Chapel Hill, since working in the clinic full time and caring for her four children prevents her from traveling to infectious diseases conferences held out of state.
“I wasn’t able to go to CROI (the Conference on Retroviruses and Opportunistic Infections) in Seattle earlier this year. This morning’s speaker recapped the major findings presented there, including injectables for treatment and prevention of HIV, which are important developments to my patients,” Eichholz said.
Since many of the annual HIV update’s speakers are UNC infectious diseases specialists, Alexander said she enjoys watching her coworkers shine.
“I like seeing my colleagues do well and receive recognition for their expertise,” Alexander said. “They also highlight areas where I can improve how I care for my patients.”