The University of Texas Health Science Center at San Antonio’s Center for Research to Advance Community Health (ReACH) was recognized Thursday [May 19] by the White House at its 2016 National Hepatitis Testing Day observance in Washington, D.C. The White House acknowledged the ReACH Center’s initiatives to screen, evaluate and cure chronic hepatitis C virus infection in diverse health care settings serving low-income populations across South Texas.
The Viral Hepatitis Testing Recognition Award is given by the U.S. Department of Health and Human Services (HHS) and recognizes four ReACH projects that have been conducted since 2012 with funding from multiple federal and state agencies. These projects follow the new national guidelines to test everyone in the U.S. who was born from 1945 through 1965 – the baby boomers – for hepatitis C. Dr. Barbara J. Turner, director of the ReACH Center, accepted the honor at the Eisenhower Executive Office Building on the grounds of the White House.
According to HHS, honored programs were selected from nominations by state viral hepatitis prevention coordinators and national viral hepatitis advocates. Recognition is based on documented success in reaching difficult-to-contact populations, ensuring a full diagnostic workup, linking persons identified as being chronically infected into care, and tracking data on program activities.
Silent infection, severe damage
The focus on hepatitis C virus reflects the fact that more than 3.5 million persons in the U.S. have chronic hepatitis C, making it by far the most-common blood-borne infection in the nation. More than half of people living with chronic hepatitis C are unaware of having this disease because it usually causes no symptoms for decades until suddenly people find that they have developed severe liver damage. With upwards of 400,000 Texans estimated to be chronically infected, the impetus for these types of programs is clear.
“Without treatment, the disease may cause liver scarring and failure and, in some cases, liver cancer,” Dr. Turner said. “In fact, hepatitis C infection is the most common reason for liver transplantation for end-stage liver disease in the U.S. and it is also the main reason that people get liver cancer. Deaths from liver cancer are rapidly increasing in the U.S.” Deaths due to hepatitis C are at an all-time high in the U.S. and exceed all of the deaths from 60 other infectious diseases including HIV and tuberculosis. However, the dire effects of chronic hepatitis C infection can now be markedly reduced because of new, highly effective oral drugs that can cure nine out of every 10 persons with chronic infection.
Patients identified and treated
Much of ReACH’s current work stems from successes and lessons learned through an earlier screening program within an inpatient setting based in the University Health System. The U.S. Centers for Disease Control and Prevention (CDC) funded this program. In that program, 4,582 or 90 percent of eligible baby boomers were tested for hepatitis C and 175 (4 percent of all tested patients) had chronic infection. Most of these patients have been managed as outpatients and at least one-third have received curative treatment for hepatitis C.
ReACH currently has three preventive hepatitis C screening and linkage-to-care programs across the South Texas area, two of which are funded by the U.S. Centers for Medicare and Medicaid Services (CMS) as a section 1115 waiver, while the third receives support through the Cancer Prevention & Research Institute of Texas (CPRIT). All of the programs focus especially on underserved, primarily Hispanic patient populations, with emphasis placed on education, case management and linkage to new, highly-effective therapies.
The Bexar-County-based screening programs operate within five primary care clinics, two at the Robert B. Green Campus of the University Health System and three within UT Medicine-affiliated primary care clinics. UT Medicine is the clinical practice of the School of Medicine at the UT Health Science Center. Together, these clinics have screened nearly 5,000 patients and have diagnosed more than 70 with chronic infection. These patients then receive care from hepatologists primarily at the UT Health Science Center.
Rio Grande Valley effort
The second CMS-funded program operates in two federally qualified health centers in the Rio Grande Valley, the Brownsville Community Health Center and Nuestra Clinica del Valle. To date, these practices have screened more than 6,200 patients, diagnosed 72 with chronic infection, and offered treatment right in the primary care clinic with mentoring by Dr. Julio Gutierrez, a hepatologist at the Texas Liver Institute, a San Antonio treatment and research facility. This work is now leading to increasing numbers of patients being cured of hepatitis C after only 12 weeks of therapy.
Team initiative
The CPRIT-funded program, STOP HCC (Screen, Treat or Prevent Hepatocellular [Liver] Cancer) seeks to achieve this goal through a screening and treatment program for low-income populations in 15 Texas counties. STOP HCC is directed by Dr. Turner at the ReACH Center in collaboration with a multidisciplinary team at the UT Health Science Center at San Antonio, the Cancer Therapy & Research Center at the UT Health Science Center, UT Southwestern, Parkland Health and Hospital System, and UT Southwestern Cancer Center. STOP HCC is being rolled out in 12 primary care clinics affiliated with Parkland and 18 primary care clinics across 14 South Texas counties with a majority Hispanic population. The goal of this project is to screen 20,000 patients and to educate physicians, staff and residents throughout Texas about hepatitis C and liver cancer. This initiative is urgent, as Texas has the second highest rate of liver cancer in the nation.
Dr. Turner is a practicing general internist and a health services researcher who joined the School of Medicine in 2010 from the Perelman School of Medicine at the University of Pennsylvania. She is the James D. and Ona I. Dye Professor of Medicine at the UT Health Science Center San Antonio.
UT Medicine San Antonio is the clinical practice of the School of Medicine at the UT Health Science Center San Antonio. With 800 doctors – all School of Medicine faculty – UT Medicine is the largest medical practice in Central and South Texas. Expertise is in more than 100 medical specialties and subspecialties. Primary care doctors and specialists see patients in private practice at UT Medicine’s flagship clinical home, the Medical Arts & Research Center (MARC), located at 8300 Floyd Curl Drive, San Antonio 78229. Most major health plans are accepted, and UT Medicine physicians also practice at several local and regional hospitals. Call (210) 450-9000 to schedule an appointment, or visit www.UTMedicine.org for a list of clinics and phone numbers.