Hepatitis and Primary Care Integration

In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. According to CDC estimates, 3.5 million people in the United States are living with the hepatitis C virus (HCV) and over 850,000 people are living with the hepatitis B virus (HBV, CDC, 2017). Recent outbreaks of hepatitis A, hepatitis B, and hepatitis C have been linked to the opioid epidemic through both injection and non-injection drug use (CDC, 2018). Although baby boomers (adults born between 1945-1965) have the highest prevalence of chronic hepatitis C infection, the highest incidence of new hepatitis C cases occurs among young adults aged 20-29 years (CDC, 2017).

Many individuals at risk for or living with viral hepatitis are members of vulnerable populations and underserved communities. These individuals may also be at risk for other illnesses or chronic conditions, including HIV and substance use disorder.

Health centers emphasize coordinated and comprehensive care, and the ability to manage patients with multiple health care needs. Primary care integration of viral hepatitis testing, vaccination, other prevention, care, and treatment can increase access and improve health outcomes for at-risk patients and patients with chronic infection. Health centers report data on hepatitis B and hepatitis C testing and diagnoses as part of the Uniform Data System.

  • In 2017, health centers tested 718,715 patients for hepatitis B and provided services to 47,790 patients diagnosed with hepatitis B.
  • In 2017, health centers tested 966,976 patients for hepatitis C and provided services to 208,508 patients diagnosed with hepatitis C.

Action Steps and Guidelines for Health Centers

The National Viral Hepatitis Action Plan 2017-2020 details specific opportunities for health care providers, patients, and community leaders to help address viral hepatitis. Hepatitis A and hepatitis B are vaccine preventable. Viral hepatitis testing and vaccination are covered preventive services (CDC, 2016). Viral hepatitis can be a short-term illness, but hepatitis B and hepatitis C can become a long-term chronic infection.

Health centers working to improve viral hepatitis clinical quality and advance integration of hepatitis-related services into primary care may benefit from the following resources.

Screen and Understand Results

The only way to diagnose chronic viral hepatitis is blood testing. Viral hepatitis screening includes multiple tests and can be complex. These resources may help to identify which tests are most appropriate for your patient.

Vaccinate

Safe and effective vaccines are available for hepatitis A and hepatitis B. These vaccines are routinely provided during the primary infant vaccination series and are recommended for vulnerable adolescents and adults as well as anyone seeking protection. There is no vaccine for hepatitis C.

Treat Disease and Manage Patients

Safe and effective treatments for hepatitis B and hepatitis C are available. These treatments have been shown to reduce the likelihood of developing cirrhosis and liver cancer. They consist of oral medications and in the case of hepatitis C, treatment can result in a virologic cure.

There are also many interventions providers can recommend for people with chronic hepatitis B and hepatitis C to stay healthy and decrease the chance of disease progression. These include reducing alcohol intake, maintaining a healthy weight, using care with over-the-counter medications, and receiving regular care including monitoring for liver cancer.

Additional Resources

Provider Training and Resources