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HCV Prevalence Underestimated, Screening Programs Needed; Immigrant Populations; IDUs; Neighborhood-Based Screening/Linkage-To-Care
  Jules Levin, NATAP
from Jules: I think NYC estimates about 150,000 with chronic HCV and they estimate about 50% are unaware they have HCV. Of course we all know HCV surveillance data everywhere in the USA & for that matter globally is inaccurate, because proper surveillance has never been conducted and current surveillance reporting is based on the numbers of HCV cases reported. We all know that all HCV cases are not reported. We all know that well done comprehensive HCV screening/testing programs are not implemented anywhere, they are not funded! So surveillance is always unreliable, everyone knows that. HCV surveillance is likely greatly underestimated, I have been saying since 2000 that HCV prevalence in NYC is at least 500,000 and across NYS 600,000, perhaps as much as 700,000. For the same 2 reasons mentioned below: immigrant populations & underestimates of HCV among IDU community. In addition, screening even outside these aforementioned communities has not been adequately conducted, even among baby boomers, so perhaps we have 750,000 with HCV in NYS. Then of course there is the incarcerated population, where across the USA its estimated 30% or more have HCV, and in NYC it might be higher.
A recent CDC study reported there are 6.6 million in the USA who have ever injected drugs, and they estimate that approximately 774,434 adults and adolescents (range: 494,605-1,054,263) injected drugs in the past year in the United States [http://www.natap.org/2014/HCV/053014_01.htm]. Since NYC is the epicenter for IDU if you only take 10% of the 6.6 mill that alone is 660,000 and I don't think this study included immigrant populations & likely underestimated the numbers of IDUS. The study even says that this is likely an underestimate as well due to IDU underreporting, and to housing & transiency issues for IDUs, in trying to survey this population. All we can do is guess as to the true numbers with HCV without good screening programs. Let's keep in mind its estimated 80-90% of IDUs are considered to have HCV.
The seroprevalence of HCV in many other countries is high ranging from 2-5% in many countries where immigration to the USA & NYC has been significant. In NYC we have 1 million Chinese; NYC is home to the largest number from India in the USA with over over 200,000 from India in NYC
The tristate area has over 1.6 million Russians. I believe there are 50,000 from Pakistan in NYC. So I will estimate there are 2 million with HCV from various immigrant populations. One small study from 2006 estimated 28% HCV prevalence among Russians in NYC ....http://www.natap.org/2006/DDW/DDW_04.htm. In Russia HCV prevalence among IDUs is an estimate 70%. In South Asia (India, Pakistan) HCV prevalence is estimated at about 4%, In Eastern Europe its estimated at 2.5-3.0%. We have an Egyptian community in the tri-sate area, prevalence is 15% in Egypt. And African immigrants, HCV is prevalent in many areas of Africa at 3-4%. In Taiwan HCV prevalence in 4.5%
Considering the broad range of countries immigrants may bring a variety of genotypes with them, so not everyone is genotype 1. Many may find it surprising that genotype-3 is the second most common genotype worldwide, and that its prevalence varies quite a lot across countries and continents. HCV GT-1 is the most prevalent HCV genotype worldwide, comprising 83.4 million cases (46.2% of all HCV cases), approximately one-third of which are in East Asia. [Messina et al. Hepatology 2015; 61:77-87.] GT-3 is the next most prevalent globally (54.3 million, 30.1%). [Messina et al. Hepatology 2015; 61:77-87.] GT-3 prevalence is 70% in India & Pakistan, 47% in UK, 28% in Germany, 30% in Brazil, 22% in Canada; and there are hints that among IDUs GT-3 has a higher prevalence than one might expect.
Genotype 3 - A Special Genotype - (09/16/15)
And there are also genotypes 1-6 that are prevalent as well in many Asian & other areas where HCV is prevalent:
Gilead Announces SVR12 Rates from Four Phase 3 Studies Evaluating a Once-Daily, Fixed-Dose Combination of Sofosbuvir (SOF) and Velpatasvir (VEL) (GS-5816) for the Treatment of All Six Hepatitis C Genotypes - (09/22/15)
NYC has always been the epicenter for IDU for 60 years now.
Screening Programs: In order to be able to address HCV in NYC we need awareness & screening projects.
- We need to conduct screening projects in all the affected communities, including the various immigrant populations. And of course we need well designed culturally appropriate linkage to care & patient education programs.
- Then we will need trained staff to conduct these screening programs, and organizations that have been already conducting HCV screening throughout NYC should be at the forefront in leading this effort.
- We need community-based screening programs.
- This means we need "local" screening & linkage to care programs, which means every neighborhood should have an HCV awareness and screening program within that neighborhood that is culturally appropriate for that community.
- Of course then we need adequate & well trained treatment & care programs designed to be able to provide care & treatment for those identified with HCV.
- Fortunately, in NYC we have as many as 15 or more public & private hospitals & clinics throughout NYC where they already treat HCV. This already provides a care system to begin to utilize.
- So for example, we should have several screening programs throughout the Brighton Beach area for Russians. There are several large Chinese communities, in Queens & Brooklyn, where culturally appropriate screening should take place.
- We will need to train staff for screening, and patient education for HCV disease and care & treatment. We will need to develop direct linkage agreements from screening sites to hospitals & clinics.
- We will need good care & treatment systems within the hospitals & clinics, meaning culturally appropriate patient support services, patient HCV disease education like we have in HIV, and of course we want to make sure we have a well trained clinician population schooled in up to date care & treatment.
- We will need clinicians able & willing to treat IDUs and those with a history of IDU.
Toward a more accurate estimate of the prevalence of hepatitis C in the United States - (09/30/15)
from Jules: it has been several years since we started discussing HCV prevalence among the homeless, incarcerated, and on Indian reservations. But few have been discussing the impact of immigrants on HCV prevalence. For many years I have been saying I think the HCV prevalence in the US is 8-9 million, this is based on that I estimate 1-2 million immigrants in the USA have HCV and that HCV among IDUs & the homeless are underestimated. The prevalence of HCV among IDUs are I think also underestimated and this never gets discussed either.

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