Tackling Hepatitis C for Liver Health

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Rachelle Bogue and Jose Martinez

Tackling Hepatitis C and Saving Lives

Rachelle Bogue, Health Care Coordinator at Tiburcio Vasquez Health Center (TVHC), along with colleagues, uncovered data about patients that is potentially saving lives. When they set on a course to test patients for Hepatitis C (Hep C) last year, the TVHC team discovered that more people than they suspected had the antibody.

It felt doubly satisfying to Bogue to be a part of the discovery and the decision to take action. “I was born and raised in the East Bay. So it feels like I’m serving my community, I really like the Hep-C work, because it affects so many people. It’s great being able to be on the front lines to see the the different research and the bigger picture.”

According to Bogue, “Hep C is one of those diseases that you can have for several years and not even know. They call it a silent killer. It affects your liver, and some of our patients have had HEP C (HCV antibody) for 30 years, and now they start to develop cirrhosis. It can progress and get worse to the point where they need liver transplant, or they develop liver cancer. It is really important that we get them screened and treated.”

TVHC uncovered surprising data that changed the way they did business in order to save lives. In March 2016 TVHC began testing for HIV and Hep C as part of the Alameda Health Consortium’s Get East Bay Tested! initiative. The Centers for Disease Control (CDC) recommends screening for patients born within what it considers a high risk cohort, those born between 1945-1965.  But, once TVHC looked closely at their results, they decided to test all patients 13 years or older regardless of reported risks.

“The CDC recommends testing patients within the within the Baby Boomer birth cohort (1945-1965) because they are the ones most at risk, having lived before they did blood screening for transfusions and for liver transplants. But because so many of our positives were actually being identified outside of this cohort, I started wondering ‘Are we just not screening our patients well enough to know if they have risk factors? Are the patients not revealing enough to us because of a stigma that comes with screening for HIV and HEP C among the Latino population?”

Bogue dug deeper. She learned of a health center on the East Coast serving a similar population that found many of their patients were testing positive outside of the birth cohort. They changed their protocol to screen all patients 13 and older. In collaboration with the chief medical officer, Bogue changed the protocol in spring 2016 to start screening all TVHC patients 13 or older regardless of risk.

After fifteen months of routine screening (Jan 2016 – March 2017) they found that 40% of those testing with HCV antibodies were born outside of the recommended age group. They will take their story on the road, sharing it at a National Association of Community Health Centers convening at the end of August.

Once patients have tested positive, Patient Navigator Jose Martinez connects them to providers and treatment. He is dogged in knocking down barriers to their care. Working as a team with the providers, who inform patients that their navigator will schedule them with a specialist, Martinez follows up with medication and insurance approvals.

Despite the hard work and the difficult emotions that a patient experiences upon testing positive, Martinez believes the screenings are worth it. “If we don’t screen 13 and over, we don’t catch a lot. The young patient I just saw today had no risk. We can’t really predict when a patient may have contracted it, but we can talk about the risk factors.” Those include injecting drugs, sharing needles, blood-to-blood pathways, and blood transfusions from earlier in the 1980s. “Sometimes it’s really simple things, like nail clippers, hairbrushes, toothbrushes. I always reassure them that if you’re willing to (treat it), it’s curable, you just have to work with us and we’ll get you there, it’s a short process.”

Martinez, who also grew up in the area, feels strongly that patients deserve an advocate. An insurance denial for medication may be 8 to 10 pages, he says, and patients may not go appeal the denial on their own. “Some of my patients do not know how to write or read and they tell me ‘I’m not going to fight it, because I don’t know how.’ I fight for them, because it’s upsetting to see them not get treatment, and I feel like if we didn’t have a system here, those people would just be left out and not cared for at all.”

Bogue agrees. “Just the other day we were tracking our numbers, how many patients we’ve tested, how many patients we’ve got on treatment, and how many patients have been cured. It’s really cool to be able to be a part of that…To be able to go and present this at a national level and have all these other community health clinics there and to be able to share our best practices and demonstrate the need for this…it’s really exciting.”