hepatitis c challenges & opportunities among justice ... · current idoc approach •consent...
TRANSCRIPT
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Hepatitis C Challenges & Opportunities
among Justice Involved Persons Kristen Dauss, MD
Indiana Department of Correction
Chief Medical Officer
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Objectives
• Current treatment approaches within correctional settings
• Define the impact, growing public health and fiscal crisis of HCV in persons with justice involvement
• Understand the unique opportunities regarding HCV treatment for justice involved persons
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Jails vs. Prisons
• Jails = county • 92 counties, 92 sheriffs, 91 jails
• Prisons = state • 17 adult facilities, 4 juvenile facilities
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What we know…
• Prevalence of HCV infection in correctional institutions >> community
• Inconsistency of assessment/treatment of HCV between jails and prisons
• There are evidence based standards as well as correctional considerations
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Current IDOC Approach
• Consent
• Screen all
• Follow all closely
• Enroll all in substance use treatment
• Triage
• Treat
We are ahead of the game!
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Local Partnerships
• Sister State Agencies • ISDH
• Response teams (Division of HIV/STD/Viral Hepatitis, CMO, Project ECHO, lab)
• FSSA • OMPP (Medicaid data sharing, HCV Tx Medicaid)
• Community Partners/Researchers • VA
• Grassroots Community/County initiatives
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National Partnerships
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Challenges
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Opportunities
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Structure: Louisiana will pay a drug manufacturer for unlimited access to
treatment for individuals in Louisiana for a set annual cost over a set contractual period
Populations included: Medicaid, Corrections
Amount: Annual payment to the manufacturer would be equal to or less than what the state
is currently spending annually to provide antiviral medications to these populations
$30M in Medicaid, $5M in Corrections (pre-
rebate)
Outcome: “Win-win-win” Manufacturers: predictable
revenue, gain in market share, good news
State: predictable expenditures, opportunity to eliminate HCV
Patients: increased SVR, reduced morbidity, reduced
mortality
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HUGE Opportunity = HCV Elimination • Continue screening • Implement EBP • Expand provider capacity to treat HCV • Educate persons incarcerated (via
healthcare staff, peer educators, technology, incorporate other IDs)
• Press for support • Implement harm reduction and
complementary treatment strategies • Establish community and correctional
linkages (Medicaid, enhanced continuity of care)
• Extend elimination efforts to all jails
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Thank you!
Questions…
Kristen Dauss, MD
Chief Medical Officer
Indiana Department of Correction
302 W. Washington Street, Room E334
Indianapolis, IN 46204
Office: 317.233.2449
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Sources:
• Hepatitis C Drugs: A Look at Emerging “Netflix” Payment Models and Patient-Centered Outcomes Research. NASHP. 05/15/2019.
• Hepatitis C Affinity Group. Opt-Out Screening and Treatment in Corrections. 05/13/2019.
• http://www.aca.org/ACA_PROD_IMIS/Docs/OCHC/HCVinCorrectionalSetting_Final.pdf Accessed 06/21/2019.