Inertia No Cure For City's Rising Hepatitis C Crisis

Not long ago, the Houston City Council discussed the best approach in dealing with the issue of Hepatitis C, a growing health concern in Houston as well as the rest of the country. The City Council is divided, and patient-advocacy groups throughout the city are turning up the pressure for a decisive response.

Hepatitis C is a blood-borne viral infection that affects the liver and is the No. 1 liver disease leading to liver transplantation. Risk factors for Hepatitis C include blood transfusions before 1992, intravenous drug use or the snorting of drugs, tattoos or body piercing and sexual promiscuity. It's estimated that approximately 2 percent of the population is infected with this virus. Groups within the population, including African-Americans and Latinos, are known to have prevalence rates that are higher than average, grossly underestimating the 2 percent prevalence rate widely quoted by the Centers for Disease Control.

In the city of Houston, this means there are roughly 40,000 infected individuals, and an additional 60,000 to 80,000 in the suburbs. Over 380,000 citizens could be infected throughout Texas, many of whom do not even know they are infected. Dealing with the Hepatitis C problem here will continue to be a struggle unless a comprehensive plan is developed. The potential flood of newly diagnosed patients could overwhelm the Harris County Hospital District and city clinics. The price tag for all this is staggering. While screening is relatively inexpensive, treatment for Hepatitis C costs approximately $12,000 per year per patient treated.

Dr. Mary des Vignes-Kendrick, director of the City Health Department, has to make the decision whether or not to commit to a citywide Hepatitis C program by appropriating additional funding or cutting from existing programs such as well-baby care, prenatal testing and immunization programs.

In my opinion, the only way to solve the Hepatitis C problem in Houston is to create a partnership throughout the community with physicians, nurses and hospitals committed to tackling this public health problem.

All those at risk must be tested. Primary care physicians should take extra time to ask about Hepatitis C risks and, where appropriate, arrange for testing. Insurance companies and HMOs will cover this expense, costing between $8 and $25. Screening through the Harris County Hospital District is available if ordered by a physician. This should capture the majority of those who need to be tested. For the remainder, free screening programs can be organized through organizations such as the Montrose Clinic and the Texas Liver Coalition. Grant money has been appropriated and is currently being used for free testing through the city. Support from the pharmaceutical industry is being offered.

Quick and certain steps need to be taken `in terms of education, prevention and screening, utilizing the maximum resources available from the city and county. A few committed non-profit agencies already exist and have been hard at work for years addressing some of these specific health needs. Hospitals and physicians interested in the care of these patients should offer time for community service to reduce the overall cost. More community support is needed for those agencies and their noble efforts, which can work in partnership with plans put forth by the city and county health departments. At this time, the city plans on focusing its efforts on conducting studies to determine the prevalence of Hepatitis C in Houston. The goal is to define the magnitude of the problem allowing the city to appropriate the necessary resources.

But, why don't we focus on the known high-risk groups and start the testing? Focus on educating these high-risk groups, developing educational materials that can be circulated and having health professionals speak to them at their churches and community centers. This approach may allow us to see the burgeoning problem of Hepatitis C in a better light.

Dr. Joseph Galati, medical director of the St. Luke's Texas Liver Institute, specializes in the care of patients with liver disease. This article originally appeared in the Houston Chronicle.

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©2006 Texas Medical Center

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