Cherokee Nation Health Services HCV Elimination Program

Cherokee Elimination Program Leadership

Cherokee Nation Health Services HCV Elimination Program

Virus targets
Hepatitis C
Type
Testing and treatment implementation
Setting
Micro elimination
Other targets
HIV
Phase
Active
Health outcomes
Incidence
Mortality
WHO region
Region of the Americas
Country
United States of America
Key interventions
Persons who inject drugs: HCV cure as prevention
Persons who inject drugs: Medication assisted therapy
Screening and diagnosis
Strategic data analysis
Treatment (direct or referral)
Target population
Adults
Performance target
Care cascade: Evidence of current infection
Care cascade: HCV diagnosis
Care cascade: HCV testing
Care cascade: HCV treatment
Care cascade: Referred for treatment
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Health outcomes additional info

We are in the phase of evaluating if obtaining the HV Incidence and HCV Mortality data for the Cherokee counties is even possible. We are working with the Oklahoma State Health Department. If this turns out to be feasible we will be using the National targets of 90% reduction in Incidence by 20130 and 65 % reduction in mortality

Summary and objectives

The Cherokee Nation Health Services (CNHS) HCV elimination program goals are aligned with the United States National goals to reduce the incidence of HCV by 90 % and mortality by 65% by the year 2030. Our objectives are to screen 85 % of the individuals who access the CNHS, link 85 % of those with a current infection (HCV RNA +) to HCV care, treat 85 % of those linked to care, and document a cure in 85 % of those who have initiated treatment. Our main strategies have been 1) Securing tribal leadership support and commitment to our program, 2) Implementation of HCV universal screening (individuals 18 years or older), 3) Utilizing ProjectECHO to expand the HCV primary care workforce to include nurse practitioners, physician assistants, physicians and pharmacists in the evaluation and treatment of individuals with HCV 4) Incorporation of dedicated patient navigators, case managers, community health workers and drug and alcohol counters, 5) decentralization of HCV care by offering HCV evaluation and treatment in the CNHS hospital and outlying clinics and 6) harm reduction interventions such as treatment as prevention and medication assisted treatment. We have partnered with the Centers for Disease control (CDC), the Oklahoma State Health Department (OSHD) and the Polaris Institute. The CDC has provided us with technical support since the initiation of the elimination program and we have recently implemented the global hepatitis outbreak and surveillance technology program with the objective of identifying clusters of transmission to enable us to target harm reduction and treatment interventions with greater efficiency. The OSHD has assisted us with a public awareness campaign and we are currently working with them in obtaining the measurements of HCV related mortality and HCV incidence in the Cherokee counties as well as with contact tracing. The partnership with the Polaris Institute is recent and we will be working together in the mathematical modeling of our program to be able to guide us with the most effective interventions to achieve our goals. The elimination program was implemented in November of 2015, as of December of 2018 92,358 individuals 18 years or older have accessed the CNHS of which 47,304 (50.9 %) have been screened. Of those individuals with a confirmed current infection (HCV RNA +), 65.4 % have been linked to care, 71.7 % have initiated treatment and 95.1 % of those who have completed treatment and have an SVR 12 data available have been cured. In the next 2 years we will be focusing on optimizing our cascade of care by improving our screening program, expanding harm reduction interventions and evaluating other strategies to enable us to engage in care those individuals that have been difficult to reach in the past few years.

The program has been highlighted in the following outlets:
https://apnews.com/article/f75e3657a1514a9c877b451bac38f286

https://www.hiv.gov/blog/at-the-forefront-of-public-health-the-cherokee…

https://www.healthline.com/health-news/cherokee-nation-trying-to-elimin…

https://www.worldhepatitisalliance.org/news/aug-2017/cherokee-nation-am…

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