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Ryan White Care Hepatitis C & B Language
  My effort that eventually led to integration of HCV into the RWCA started about 9 years ago. I toured and visited major cities throughout the USA to assess and evaluate coinfection and HCV to see what if any programs were ongoing and the viability of funding possibilities from City and State sources. After realizing there was essentially no funding ongoing and little interest in funding from State and City sources I went to Washington DC. I met with key Senate, House and Administration officials. Upon assessing which effort would be the easier to accomplish in a short period of time, mono- or coinfection, I decided on coinfection. So, I started a National Coinfection Coalition composed of 100 organizations and started a website for the coalition, which still exists. Myself and Coalition members started meeting with Congress and the Admiministration 6 years ago. We held the first HCV Briefing in the House cosponsored by the Congressional Black Caucaus, followed by briefings in the Senate and the House sponsored by Kennedy, Democrats and Republicans, all over the course of 5 years. I educated Congressional staff about what the problems were and the language in the RWCA should say and what issues should be addressed. The reauthorized RWCA in Dec 2006 contained the following language. No funding was mandated probably because HIV lobby groups were afraid to share any money with HCV. Congress said the language in here is for RW Councils throughout the USA to use but its up to them to fund it. Jules Levin, Executive Director/Founder, NATAP.

Most of the approximately five million Americans infected with the hepatitis C virus (HCV) are unaware they have a transmissible and potentially deadly disease, precluding them from initiating treatment and implementing behavioral changes that can save their lives.
The CDC estimates about 25 percent of Americans with HIV/AIDS are co-infected with HCV. End-stage liver disease secondary to chronic hepatitis C infection is now the leading cause of death among people with HIV/AIDS in the United States.
Despite the high rate of mortality due to hepatitis C among people with HIV/AIDS, only a handful of traditional AIDS service providers, including a few CARE Act grantees, have begun to address this critical issue. This issue is particularly problematic in large urban areas where the majority of HCV/HIV co-infected patients live and receive services.
The main problem is that this is not just a matter of ADAP providing HCV drugs for co-infected patients, it relates to all medical and social service providers recognizing the impact of HCV on persons with HIV, getting the proper training to help these individuals, and integrating the appropriate services into their programs.
Part A grantees contracted with over 1,500 agencies to offer social support and medical care services to over 800,000 patients in 2003. The majority of patients served under Part A are racial and ethnic minorities, African Americans, in particular, who are disproportionately impacted by both HIV and HCV. Part A providers, as do providers funded under other parts require the guidance, expertise and resources to adequately serve their HCV/HIV co-infected patients.
Some studies have reported that people with co-infection have higher levels of hepatitis virus in their blood, more rapid progression of liver damage, and a greater rate of death due to hepatitis than people with only HCV infection. Other recent research found no correlation between HCV progression and HIV status. Hepatitis B (HBV) is the most common viral hepatitis infection in people with HIV. Given this information about HCV and HBV, the Committee took a variety of actions throughout the legislation to acknowledge these issues.
1. Section 106. The bill would expand required planning council representation to include Native Americans, and individuals co-infected with hepatitis B or C.
2. (PREFERENCE IN MAKING GRANTS) Section 302. The bill would give priority to qualified applicants (under the Early Intervention Services Program) "experiencing an increase in the burden of providing HIV-related services due to the number of individuals co-infected with HIV/AIDS and hepatitis B or C."
3. (COUNSELING & REFERRALS of INDIVIDUALS WITH NEGATIVE OR POSTIVE HIV TEST RESULTS). Section 305. New Bill 2006. The grantee must provide information on the prevention of exposure to and transmission of hepatitis B, hepatitis C, and other sexually transmitted diseases, the accuracy and reliability of testing for hepatitis B and hepatitis C; significance of test results, including potential for developing hepatitis B or hepatitis C; the appropriateness of further counseling, testing and education of the individual regarding other sexually transmitted diseases; if diagnosed with chronic HBV or HCV coinfection, the potential of developing hepatitis-related liver disease and its impact on HIV/AIDS; and information regarding the availability of hepatitis B vaccine and hepatitis treatment.... The benefits of locating and counseling any individual by whom the infected individual may have been exposed to HBV or HCV, and any individual whom the infected individual may have exposed to HBV or HCV, emphasize that it is the continuing duty of the individuals to avoid any behaviors that will expose others to HBV or HCV. --The language of the 2000 bill requires referral of individuals: referrals of individuals with HIV disease to appropriate providers of health and support services, including, as appropriate.
SEC. 2612. [300ff-22] GENERAL USE OF GRANTS (HOME COMMUNITY BASED CARE). (a) IN GENERAL.-A State may use amounts provided under grants made under this part-
(1)8 to provide the services described in section 2604(b)(1) for individuals with HIV disease;
(2) to establish and operate HIV care consortia within areas most affected by HIV disease that shall be designed to provide a comprehensive continuum of care to individuals and families with HIV disease in accordance with section 2613; (3) to provide home-and community-based care services for individuals with HIV disease in accordance with section 2614;
(4) to provide assistance to assure the continuity of health insurance coverage for individuals with HIV disease in accordance with section 2615; and (5) to provide therapeutics to treat HIV disease to individuals with HIV disease in accordance with section 2616.
NEW 2006 BILL H.R. 6143:
The bill would modify the coordination activities of the home and community based health service providers to include coordination of speciality care for individuals with hepatitis co-infection.
(SEC. 2614. [300ff-24] GRANTS FOR HOME-AND COMMUNITY-BASED CARE.) p.15, in the home

(1) IN GENERAL.-The purposes for which a grant under this part may be used include providing to individuals with HIV disease early intervention services described in section 2651(b)(2), with follow-up referral provided for the purpose of facilitating the access of individuals receiving the services to HIV-related health services. The entities through which such services may be provided under the grant include public health departments, emergency rooms, substance abuse and mental health treatment programs, detoxification centers, detention facilities, clinics regarding sexually transmitted diseases, homeless shelters, HIV disease counseling and testing sites, health care points of entry specified by States or eligible areas, federally qualified health centers, and entities described in section 2652(a) that constitute a point of access to services by maintaining referral relationships.
(2) CONDITIONS .-With respect to an entity that proposes to provide early intervention services under paragraph (1), such paragraph applies only if the entity demonstrates to the satisfaction of the State involved that-
(A) Federal, State, or local funds are otherwise inadequate for the early intervention services the entity proposes to provide; and
(B) the entity will expend funds pursuant to such paragraph to supplement and not supplant other funds available to the entity for the provision of early intervention services for the fiscal year involved. (d) QUALITY MANAGEMENT.-
(1) REQUIREMENT.-Each State that receives a grant under this part shall provide for the establishment of a quality management program to assess the extent to which HIV health services provided to patients under the grant are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infection, and as applicable, to develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV health services. (2) USE OF FUNDS.-From amounts received under a grant awarded under this part for a fiscal year, the State may (in addition to
amounts to which section 2618(b)(5) applies) use for activities associated with the quality management program required in paragraph (1) not more than the lesser of-
(A) 5 percent of amounts received under the grant; or
(B) $3,000,000.
(3) REFERRALS (EARLY INTERVENTION PROGRAM).-The services referred to in paragraph (2)(C) are
referrals of individuals with HIV disease to appropriate providers of health and support services, including, as appropriate- (A) to entities receiving amounts under part A or B for the provision of such services;
IN GENERAL.-The Secretary may not make a grant under subsection (a) unless the applicant for the grant agrees to expend the grant for the purposes of providing, on an outpatient basis, each of the early intervention services specified in paragraph (2) with respect to HIV disease, and unless the applicant agrees to expend not less than 50 percent of the grant for such services that are specified in subparagraphs (B) through (E) of such paragraph for individuals with HIV disease.
SPECIFICATION OF EARLY INTERVENTION SERVICES.-The early intervention services referred to in paragraph (1) are- (A) counseling individuals with respect to HIV disease in accordance with section 2662;
(B) testing individuals with respect to such disease, including tests to confirm the presence of the disease, tests to diagnose the extent of the deficiency in the immune system, and tests to provide information on appropriate therapeutic measures for preventing and treating the deterioration of the immune system and for preventing and treating conditions arising from the disease;
(C) referrals described in paragraph (3); (D) other clinical and diagnostic services regarding HIV disease, and periodic medical evaluations of individuals with the disease;
(E) providing the therapeutic measures described in subparagraph (B). (3) REFERRALS.-The services referred to in paragraph (2)(C) are referrals of individuals with HIV disease to appropriate providers of health and support services, including, as appropriate- (A) to entities receiving amounts under part A or B for the provision of such services;
(B) to biomedical research facilities of institutions of higher education that offer experimental treatment for such disease, or to community-based organizations or other entities that provide such treatment; or
(C) to grantees under section 2671, in the case of a pregnant woman. (4) REQUIREMENT OF AVAILABILITY OF ALL EARLY INTERVENTION
(A) IN GENERAL.-The Secretary may not make a grant under subsection (a) unless the applicant for the grant agrees that each of the early intervention services specified in paragraph (2) will be available through the grantee.
(a) IN GENERAL.-The entities referred to in section 2651(a) are public entities and nonprofit private entities that are-
(1) migrant health centers under section 329 or community health centers under section 330;
(2) grantees under section 340 (regarding health services for the homeless);
(3) grantees under section 1001 (regarding family planning) other than States;
(4) comprehensive hemophilia diagnostic and treatment centers;
(5) Federally-qualified health centers under section 1905(l)(2)(B) of the Social Security Act; or
(6) nonprofit private entities that provide comprehensive primary care services to populations at risk of HIV disease.
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