VA Portland Health Care System
Waging War on Hepatitis C
VA Portland Cures Thousands of VeteransBy Anna Robaton-Winthrop, VA Portland Public Affairs Volunteer
In 2004, Army Veteran Chris Mumford got alarming news. During an emergency-room visit for a lung infection, he tested positive for hepatitis C — a viral infection that can lead to advanced liver disease, liver cancer and early death.
To make matters worse, Mumford later learned that he wasn’t a candidate for the drugs that were used by the Veterans Health Administration to treat the disease in the early 2000s.
So, imagine his surprise, when in 2016 — a decade after learning that he had hepatitis C — Mumford received a letter from the VA letting him know that help was within reach.
“I was elated,” says Mumford, recalling his reaction when he learned that treatment through the VA had become an option for him.
Today, Mumford of the Dalles, Ore., is one of more than 100,000 Veterans who have been cured of hepatitis C by the VA. The VA Portland Health Care System (VAPORHCS) alone cured more than 95 percent of infected Veterans within its population (nearly 2,200 people) between fiscal 2015 and 2019. During that period, it also screened nearly 40,000 Veterans at high risk for the disease who previously hadn’t been tested.
More than 3 million people in the U.S. are living with chronic hepatitis C, many of them Veterans. Just a few years ago, the prevalence of hepatitis C among Veterans was three times greater than that of the general U.S. population.
Many people infected with hepatitis C don’t know it — as was once the case for Mumford. The blood-borne virus often doesn’t have obvious symptoms until the onset of long-term complications.
What changed between the time Mumford was diagnosed with hepatitis C and treated for it? Quite a lot.
In early 2014, highly effective, all-oral, direct-acting antivirals became available for hepatitis C treatment. The drugs have few (and relatively mild) side effects, are taken in pill form for about eight to 12 weeks and have cure rates approaching 100 percent for patients without significant liver damage.
Earlier treatments for hepatitis C were taken for much-longer periods (typically 48 weeks) and often had debilitating side effects — not to mention cure rates of just 27 percent within the VA and about 35 percent externally. The VA adopted use of direct-acting antivirals within days of their federal approval.
That wasn’t the only game-changer. Congress also allocated some $2.5 billion for hepatitis C care within the VA. The funding helped cover the cost of direct-acting antivirals and manpower to fight the disease, which meant that VAPORHCS no longer had to prioritize the sickest Veterans for treatment of hepatitis C, says Long Do, a pharmacist who is part of the hepatitis C team at VAPORHCS’s liver clinic.
“Many of the Veterans we’ve treated are appreciative of us getting rid of a disease that they thought they’d be living with for life, or didn’t even know they had,” says Do, who has worked with his colleagues to lower barriers to hepatitis C care for Veterans served by VAPORHCS, many of whom live in remote areas.
Rather than asking Veterans to travel long distances for treatment, Do and his colleagues have taken their services on the road, traveling to VAPORHCS facilities across Oregon and in Southwest Washington to provide the kind of care that was once only available at the Portland VA Medical Center.
The team has also worked closely with VA mental health providers and programs serving Veterans who are homeless, at risk of becoming homeless or struggling with substance-abuse issues. In some instances, team members have delivered medications to Veterans who faced difficulties picking up prescriptions themselves.
“The objective has been to meet Veterans in the community, get their needs met and get them linked to care,” says Kari Stevens, a social worker on the hepatitis C team who has forged connections to high-risk Veteran populations, including homeless Veterans and those with substance-abuse issues.
For many Veterans, taking time off work for clinic visits or traveling long distances for care poses a hardship — which is why VAPORHCS’s hepatitis C team has also treated Veterans over the phone (after an initial in-person visit to a clinic) or via telehealth services. In fact, the team has come to view treating hepatitis C much like treating a routine, tooth infection, given that most people tolerate direct-acting antivirals well.
“We’ve treated thousands of Veterans, so we have a really good handle on what we need to do to treat them safely and effectively,” says Dana Smothers, a hepatology nurse care coordinator who leads VAPORHCS’s hepatitis C treatment campaign.
While he still has health issues, Mumford also has one less thing to worry about these days.
“I can’t say that hepatitis C ever really caused me a problem, but my doctors were more concerned about what it might do to my liver eventually,” says Mumford, part of an all-Veteran band, called “Got Your Six,” that supports Veterans’ causes.
He urges fellow Veterans who haven’t been tested for hep C not to wait, especially since treatment options have come a long way.
“Go find out, if you haven’t been checked. The treatment is not hard to do,” says Mumford.
For more information on viral hepatitis and liver disease as well as other resources visit: https://www.hepatitis.va.gov/