For the longest time in North Carolina, the prospects of hepatitis C treatment for an injection drug user looked pretty bleak. Few pharmacies sell syringes without a prescription and needle exchange programs were only legalized in July 2016, so contracting hepatitis C is a real risk for people who regularly use syringes. Additionally, because so few drug users have medical insurance, even the remarkable medical advances in hepatitis C treatment over the past couple of years remain out of reach for the population who needs treatment the most. Even those who have insurance are often denied care by medical providers or insurance companies, including Medicaid, that require a period of abstinence from illicit drugs to treat patients for hepatitis C.
But now, thanks to a grant funded by the FOCUS Program of Gilead Sciences and run by the North Carolina Harm Reduction Coalition (NCHRC), there is finally hope.
Last April, NCHRC launched a new hepatitis C testing and linkage to care program in Greensboro, North Carolina. The program operates primarily in the Urban Survivor’s Union syringe exchange program and offers free HIV and hepatitis C testing services not only to syringe exchange participants, but to other community partners such as people enrolled in methadone clinics and substance use treatment centers. This low-threshold program allows anyone to walk into the exchange and request a test either through a blood draw by a certified phlebotomist or through an oral swab test kit.
“We try to make it easy and comfortable for people to get tested,” says Sonia Watson, the program phlebotomist. “We ask people to fill out a couple of forms and then we draw blood and send it to the lab. We are seeing more participants every day. People are very interested in knowing their status.”
HIV and hepatitis C testing services have been offered in the area before, but the challenge has always been how to connect a population that is largely uninsured to treatment services. In the past, once people were tested and referred, most never made it to treatment due to lack of medical insurance or funds, unreliable transportation, difficulty navigating the bureaucracy of the healthcare system, physician’s stigma against treating active drug users, and numerous other obstacles.
The new program meets that challenge head-on by hiring a Linkage to Care Specialist, Shakira Bethea, whose task is to help people enroll in hepatitis C treatment programs and complete their treatment. Shakira has been reaching out to physicians in the area to find those who are willing to work with active drug users and uninsured patients, as well as working to overcome bureaucratic and transportation barriers for people to receive care.
“Getting in touch with providers has been difficult, but we are making progress,” says Shakira. “We are also working on a partnership with UNC Chapel Hill because they have a program for the uninsured and a pharmacy program to administer medications at a reduced cost. If there is a delay with getting someone into treatment, I look for support programs so that at least they are able to start getting education and support.”
The hepatitis C program staff has had to get creative to overcome the challenge of transportation to UNC Chapel Hill for the uninsured. Greensboro and Chapel Hill are over an hour apart by car and several hours apart by public transportation. To overcome this barrier, staff secured a grant from the National Viral Hepatitis Roundtable to fund a ride-sharing program that pays Lyft or Uber drivers to transport patients to and from appointments in Chapel Hill.
Before and throughout the treatment process, participants who test positive for hepatitis C are enrolled in harm reduction support groups led by Louise Vincent, Hepatitis and Drug User Health Services Coordinator. Louise runs the syringe exchange, assists with enrolling new participants and offering the testing, and facilitates support groups where people can receive information on hepatitis C and the treatment process. Though the hepatitis C program funding began in January 2017, testing kicked off in April with an event that included focus groups and interviews on participant’s knowledge of HIV and hepatitis C.
“It took us a while to begin testing people because we wanted a clear plan for where and how to refer the people who came back positive,” says Louise. “One of our current challenges is correcting misinformation about hepatitis C and treatment for it. People are worried about side effects from the old interferon treatment and they don’t realize that the new treatment is much better and more effective.”
The Greensboro program is charting new territory in many ways. Most of Gilead’s other hepatitis C testing and linkage to care programs operate out of medical clinics or syringe exchange programs that have been long established in other states. The Greensboro syringe exchange is brand new thanks to recent legalization, so staff is faced with the dual challenge of turning a fledgling syringe exchange into a fully functional one that offers core services, as well as creating a new program for hepatitis C testing and treatment.
“It’s important to take your time and be thoughtful about putting a program like this together,” says Loftin Wilson, the Harm Reduction and Hepatitis Program Coordinator. “It takes a while to set up a program that is responsive to people’s needs and doesn’t assume things without talking to participants.”
Though the program is only just getting started, it is already bringing hope to injection drug users who thought they would never see the day that hepatitis C treatment would be made available to them.
“Not long ago I would talk to people about what we hoped we could do one day and now we are actually doing it,” says Louise. “No one believed that any program would help active drug users get treatment. I’m very impressed with the support we have received from Gilead and excited to be able to offer a service like this.”