HCV CARE

Selected Resources

For Care Providers

October 2016

EDUCATION

E-patients.net: Salzburg Statement on Shared Decision Making

New York State Department of Health (NYSDOH):

CEI: HIV, HCV & STD Clinical Education Initiative

CEI: HCV Clinical Cards (to attach to name badges; available for NYS care providers)

Communicable Disease Reporting Requirements

Directory of ESAP Providers in New York State

Hepatitis C

NYS AIDS Institute Training Center

Office of Alcoholism and Substance Abuse Services

Office of Mental Health

US Occupational Safety and Health Administration:

Bloodborne Pathogens & Needlestick Prevention

Enforcement Procedures for Occupational Exposure to Bloodborne Pathogens

University of Washington: Hepatitis C Online

NYSDOH/NYC DOHMH Patient Education Material: These message pads are designed for persons performing HCV screening/counseling to ensure that counseling messages appropriate for specific screening test results are delivered.

Non-Reactive Result/Antibody Negative 

Reactive Result/Antibody Positive 

 

GUIDELINES

AASLD/IDSA: HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C

CDC:

Recommendations for Prevention and Control of Hepatitis C Virus (HCV) Infection and HCV-Related Chronic Disease

Recommended HCV Testing Sequence

US Department of Veterans Affairs: Viral Hepatitis Guidelines and Best Practices

 

LAW

NYSDOH:

Communicable Disease Reporting Requirements

Hepatitis C

HIPAA Information Center

 

SERVICES

National Institutes of Health (NIH): ClinicalTrials.gov

New York eHealth Collaborative: NYEC

New York State (NYS):

Office for the Prevention of Domestic Violence

Office of Victim Services

NYSDOH:

Directory of ESAP Providers in New York State

Expanded Syringe Access Program (ESAP): Overview of Law and Regulations

HCV Rapid Testing Program

Hepatitis C

NYS Safe Sharps Collection Program

Office of Alcoholism and Substance Abuse Services

Office of Mental Health

Wadsworth Center

 

TOOLS

Alcohol and Drug Use Screening Tools:

AUDIT-C 3-item alcohol screen

CAGE Questionnaire

Addiction Severity Index Lite-CF

SAMSHA: Screening, Brief Intervention, and Referral to Treatment (SBIRT)

WHO: Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

Classifying the Severity of Cirrhosis:

Model for End-Stage Liver Disease (MELD) Calculator

Child-Turcotte-Pugh (CTP) Calculator

NYSDOH: CEI: HIV, HCV & STD Clinical Education Initiative

Treatment Readiness Evaluation: Psychosocial Readiness Evaluation and Preparation for HCV Treatment (PREP-C)

Consumer Q/A: Treatment of Hep C with DAAs

Updated August 2017

The New York State Department of Health AIDS Institute has released a new guideline about treating Hepatitis C. This Q/A fact sheet covers the topics in the guideline and can help people talk with their healthcare providers about Hep C.

About the Guideline

What is the purpose of the guideline? The guideline is a set of recommendations for healthcare providers. It explains how treat Hep C using the new direct-acting antiviral drugs. “Direct-acting antiviral” is abbreviated as “DAA.” On average, DAAs cure Hep C in 90% or more of the people who take them.

Who wrote the guideline? The guideline was written by a group of doctors in New York who specialize in treating Hep C and liver disease. It was also reviewed by people living with Hep C. The recommendations are based on research studies and the doctors’ experience treating patients.

About Hep C

What is Hep C? Hep C is a virus that infects the liver. Most people do not have symptoms for many years.

Over time, Hep C can cause the liver to thicken and scar. This scarring is called “fibrosis.” As the scarring becomes worse, the liver does not function correctly. The late stage of scarring is called “cirrhosis.” Cirrhosis can lead to life-threatening liver failure or liver cancer. 

Treatment with direct-actiing antivirals (called “DAAs”) can cure Hep C, and cure can prevent or slow down liver damage.

How is Hep C spread? Hep C is spread when the blood of a person who has the virus enters the body of a person who does not have the virus. Hep C is not spread through casual contact, such as sneezing, hugging, or sharing eating or drinking utensils.

Who should get tested for Hep C? If you can answer “Yes” to any question below, you should get a test.

  • Were you born between 1945 and 1965? This group, the “baby-boomers,” may have been infected during the 1970s and 1980s, before the Hep C virus was discovered. Hep C testing is recommended for all people in this age group
  • Do you have HIV infection?
  • Did you have a blood transfusion or organ transplant before 1992?
  • Has a healthcare provider ever told you that you have abnormal liver tests or liver disease?
  • Do you get long term kidney dialysis?
  • Have you ever been in jail or prison?
  • Have you ever shared drug injection equipment? Even once?
  • Have you engaged in any type of high-risk sex? For instance, have you ever been the bottom during anal sex? Had sex after using methamphetamine (crystal meth, crystal, crank, ice) or other drugs? Had multiple sex partners?
  • Have you been diagnosed with a sexually transmitted infection, like syphilis, gonorrhea, or herpes, in the past year?
  • Have you ever gotten a tattoo, piercing, or acupuncture in a place that did not seem clean?
  • Are you a healthcare worker who has ever been stuck by a needle or splashed by blood from a patient?
  • Has your mother had a positive Hep C test?

If you think you might have been exposed to Hep C but are not sure, then you should get tested. For more information, visit: Should You Be Tested for Hepatitis C?

Diagnosing Hep C

How is Hep C diagnosed? Hepatitis C diagnosis requires two tests: an antibody test and an RNA test. Both tests require a blood sample.

1. Antibody test: Hepatitis C antibodies form in your blood when you have been exposed to the virus. If the antibody test is negative, then you don’t have Hep C infection. If you have engaged in risky behavior in the past 6 months, you should be tested again.

A positive Hep C antibody test by itself does not mean that you have Hep C. It means you have been exposed and might have chronic Hep C. You need an RNA test to confirm the diagnosis. 

If you have been treated for Hep C and cured in the past, your antibody test will be positive. 

2. RNA test: An RNA test measures the amount of Hep C virus in your blood. If the RNA test finds Hep C virus in your blood, then you have active Hep C infection. If Hep C virus is not detected, then you do not have active Hep C infection. 

If you do have Hep C, you should talk with your healthcare provider about treatment.

Treating Hep C

What does your healthcare provider need to know before giving you treatment? A healthcare provider needs to know about your health history and current health. She or he will ask you questions, examine you, and perform tests to help decide which medications are best for you.

What are DAAs? DAAs are pills that combine more than one medication that works directly against the hepatitis C virus to treat it. Treatment usually lasts for 12 weeks (3 months) to 24 weeks (6 months). Different combinations of DAAs work best for different people. Some people take DAAs with another drug called ribavirin.

How will your healthcare provider pick the DAA combination for you? You and your healthcare provider will work together to decide the best treatment for you. The specifics of your situation will guide the choice, such as:

  • Your Hep C genotype. Different strains of the virus are called “genotypes.” Genotype 1 is the most common in the United States.
  • Whether you were treated for Hep C before.
  • Whether you have liver damage. A simple blood test can determine if you have liver damage. A liver biopsy is no longer required.
  • Other medications you are taking.
  • The number of pills you are comfortable taking.
  • Whether you are pregnant or trying to get pregnant.
  • Whether your partner is trying to get pregnant.
  • Your health insurance: Almost all types of health insurance cover the DAAs, but not all companies cover all of the DAAs. Your healthcare provider will find out what your company covers. If you don’t have health insurance, your healthcare provider can help you find payment assistance programs.

Do DAAs have side effects? Most people don’t get side effects when they take DAAs. Some people have experienced tiredness, diarrhea, headache, trouble sleeping, and stomach upset. If you take DAAs and feel any side effects, tell your healthcare provider.

How will you know if you are cured? Your healthcare provider will perform an HCV RNA follow-up test 12 weeks (3 months) after you finish treatment. If the test does not detect Hep C virus in your blood, you are cured of Hep C infection. If there is still Hep C virus in your blood, you are not cured.

If you are not cured, then a different combination of DAAs might work for you.

Preventing Hep C After Treatment

Can you get Hep C again after you are cured? Yes. Being treated for and cured of Hep C infection does not protect you from getting it again. To protect yourself from being infected with Hep C again, do not share needles, syringes or drug use equipment, personal items like toothbrushes or razors and use condoms.