U.S. Launches Bold Plan to Tackle Hepatitis C Racial Disparities

Hepatitis C is an inflammatory liver disease caused by the hepatitis C virus (HCV). It's passed via contact with blood from someone who already carries the virus.

While hepatitis C is contagious and may not present any symptoms, it's often treatable. Screening can identify the presence of HCV and can lead to life-saving treatment.

However, healthcare inequities exist among racial groups, because not everyone has the same access to screening and treatment.

Hepatitis C overview

The American Liver Foundation (ALF) lists three main types of hepatitis: A, B, and C.

There are vaccines available to prevent hepatitis A and hepatitis B, but not for hepatitis C. However, there are antiviral medications that can treat most hepatitis C infections.

While most people recover from hepatitis, some experience liver damage (cirrhosis) or cancer. In some cases, hepatitis can be fatal.

According to the , around 290,000 people died from hepatitis C in 2019, and about 58 million people worldwide have chronic hepatitis C infections.

Race and ethnicity in hepatitis C

Research shows that the diagnosis and treatment of hepatitis C can vary between races, resulting in inequities in healthcare.

A featuring 34,810 participants born between 1945 and 1965 revealed differences in screening and positivity rates according to race:

| Race | Screening rate | Positivity rate | Chronic HCV rate | | --- | --- | --- | --- | | Asian Pacific Islander | 98.7% | 2% | 1.7% | | Black | 92.4% | 27.8% | 22.2% | | Latino | 96.5% | 8.8% | 6.9% | | Other races | 95.5% | 11% | 7.4% | | White | 92.8% | 22.9% | 15.9% |

In spite of the higher rates of HCV in African Americans, research shows that this group is more likely to be considered ineligible for treatment than non-African Americans.

The findings of a 2017 study found no clinical evidence to explain this difference, suggesting that racial discrimination could be a factor.

However, a showed that African Americans were more likely to be screened than Caucasians. The study also found that income level had no effect on screening rates, but a lower income level was connected to a higher positivity rate and a lower likelihood of receiving treatment.

published in 2020 suggests that screening and access to HCV care still have room for improvements in certain populations:

• racial/ethnic groups other than U.S.-born white and Black people
• foreign-born Americans
• those born after 1985
• people without insurance

The study found that of the people identified as living with HCV didn't know that they had the virus.

Chronic hepatitis C affects about Americans. A 2016 study that examined treatment rates for chronic hepatitis C found that white people had higher treatment rates than historically marginalized groups:

• white - 10.7 percent
• Black - 8.8 percent
• Hispanic - 8.8 percent
• Asian - 7.9 percent

In the same study, white people were the most likely to have a co-occurring psychiatric condition, at a rate of 20.1 percent, while Black people were most likely to have a co-occurring medical condition, at a rate of 44 percent.

Hispanic people had the highest rate of liver cirrhosis, at 20.7 percent, yet still had lower treatment rates than white people.

Raising awareness

The U.S. Department of Health and Human Services (HHS) has created the Viral Hepatitis National Strategic Plan. The plan includes strategies to help address the gaps in hepatitis screening and treatment, with a focus on priority populations.

One of the many motivators for this plan is the increase in hepatitis C rates, which have almost tripled between the years 2011 and 2018. The increase is likely due to the Centers for Disease Control and Prevention (CDC)'s recommendation for Hep C screening in those born between 1945 and 1965. This screening began in 2012.

For hepatitis C, the HHS has identified the following priority populations, categorized by the nature of the disease and the mortality rates:

Acute hepatitis C

• Native Americans/Alaskan Natives
• people who inject drugs

Chronic hepatitis C

• Black, non-Hispanic
• people born between 1945-1965
• people living with HIV
• people who inject drugs

Hepatitis C mortality

• Native Americans/Alaskan Natives
• people born between 1945-1965
• Black, non-Hispanic

The vision behind the HHS's viral hepatitis plan is to include all people from every category in the plan's five goals. These goals are:

• prevent new infections
• improve health outcomes for people living with hepatitis
• reduce hepatitis-related health inequities
• improve data collection and use
• coordinate efforts among federal agency partners and stakeholders

Taking action

July 25, 2013, was the first annual National African American Hepatitis Action Day (NAAHAD). The and the National Black Leadership Commission on AIDS (NBLCA) work with partner organizations to promote NAAHAD events raising awareness about hepatitis C.

The Black Health Learning Academy offers an online Hepatitis C Treatment and Prevention course that includes actionable suggestions, such as:

• increasing community awareness about hepatitis C
• encouraging screening and treatment
• reminding people how successful treatment can be

According to the CDC, May is , May 19 is , and July 28 is . These occasions provide opportunities to start educational dialogues about hepatitis C and its impact.

Takeaway

Hepatitis C is a viral liver disease that can be serious if left untreated. It's possible to have hepatitis C and not know it, because sometimes there are no symptoms.

Screening and treatment are an important part of reducing the impact of hepatitis C, but gaps exist between racial groups. Not everyone has the same access to care.

It can help to learn more about this condition and share what you've learned with others. The CDC has a you can visit for more information.

If you're interested in reading more about the Viral Hepatitis National Strategic Plan, you can download it here.