A Collaborative, Nimble Strategy to Eliminate Hepatitis A, B, and C
Hep Free Hawai‘i (HFH) is a coalition of over 90 local, national, and global partners dedicated to increasing awareness of and access to viral hepatitis and harm reduction services throughout the state of Hawai‘i. Originally a partnership between the Hawai‘i Department of Health’s Harm Reduction Service Branch, the Hawai‘i Health & Harm Reduction Center (formerly the CHOW Project and the Life Foundation), and the AIDS Community Care Team, we have grown by connecting with communities across the islands, aiming to make Hawai‘i truly “Hep Free.”
On World Hepatitis Day, July 28 2019, we partnered with the Hawai‘i Department of Health and the Hawai‘i Health & Harm Reduction Center to host the inaugural meeting to develop Hawai‘i's Hepatitis Elimination Plan. It was attended by 45 stakeholders including patients, consumers, medical and social service providers, policymakers, among others. The meeting was also attended by Lieutenant Governor Josh Green, who proclaimed hepatitis elimination an important priority for Hawai‘i.
This strategy aligns with recommendations from other plans:
CDC Winnable Battles Framework United States Centers for Disease Control and Prevention
National Viral Hepatitis Action Plan United States Department of Health and Human Services
National Strategy for the Elimination of Hepatitis B and C The National Academies of Science, Engineering, and Medicine
Global Health Sector Strategy on Viral Hepatitis, 2022-2030 World Health Organization
Since our beginnings, we have been co-directed by a representative from a community-based organization and a representative from the Hawai‘i Department of Health. This public-private partnership has allowed us to better respond to the changing health and social environment. This joint strategy document that will be guided, implemented, and evaluated by all participating partners and stakeholders including the Hawai‘i Department of Health.
“Hep Free 2030: The Hawai‘i Hepatitis Elimination Strategy 2020-2030” aims to eliminate hepatitis in Hawai‘i by addressing viral hepatitis along the continuum of a “care cascade” or “result chain”, step-wise frameworks that reflect the need for a multi-pronged, intersectional approach to truly eliminate hepatitis. This strategy is intended to integrate with other local plans, including “H20: Hawai‘i HIV Elimination Plan.”
What does hepatitis elimination mean?
According to the World Health Organization, hepatitis "elimination" would be when new cases of disease become zero (or at least very low) in a certain area. This means that we will be figuring out ways to prevent new hepatitis infections and to care for people who are already living with hepatitis in Hawai‘i.
By the Numbers
Hepatitis is a major issue for Hawai‘i. Looking at the numbers (quantitative) and listening to stories of the people (qualitative), we continue to learn more about:
· who are most affected by viral hepatitis in Hawai‘i
· where we should focus our efforts
· what is (or isn’t) working, so that we can adapt quickly
· how to educate policymakers to make systems-level change
Basically, these data help us tell the story of viral hepatitis in our local communities. Unfortunately, the Hawai‘i Department of Health does not receive adequate funding for meaningful hepatitis B and C surveillance. So how do we know what’s happening? Using other data sources, here is the story so far:
Liver Cancer Is High
Hawai‘i has one of the highest rates of liver cancer in the United States. For every 100,000 people in Hawai‘i, 10 new liver cancer cases were reported (201 people total), and 8 people died of liver cancer (158 people total) in 2016.
Hepatitis A Affects Houseless People
The CDC recommends all houseless persons get vaccinated for hepatitis A. As of 2019, about 6,400 people in Hawai‘i were considered houseless
and should receive hepatitis A immunizations.
Viral Hepatitis Causes Liver Cancer
The leading causes of liver cancer in Hawai‘i are hepatitis B virus (HBV) and hepatitis C virus (HCV), which account for 2 out of 3 cases of liver cancer.
Viral Hepatitis Affects Sexual & Gender Minorities
At least 1 in 10 lesbian, gay, bisexual, and transgender (LGBT) public high school students in Hawai‘i reported injecting drugs at least once before graduating; 1 in 4 of these LGBT youth also reported using prescription drugs without a prescription. Increase in injection drug use has been closely linked with opioid misuse and its sequelae, especially HCV infection and drug overdose.
Hepatitis B Affects Asians & Pacific Islander People (API)
The CDC recommends that people born in Asia or the Pacific regions get tested for hepatitis B, followed by linkage to either immunizations or treatment. Almost half of the people in Hawai‘i identify as API (not including people who identify as multi-racial), and about 1 out of 5 people in Hawai‘i were born outside of the U.S.
From 2013-2015, the Department of Health’s Enhanced Hepatitis B Screening Program at Kalihi-Palama Health Center found an HBV prevalence of 5.9% among Pacific Islanders, primarily from Chuuk (in the Federated States of Micronesia) and the Marshall Islands.
Hepatitis C Screening Is Recommended for 80% of Hawai‘i
The CDC recommends that all adults over 18 years old receive testing for hepatitis C, regardless of any known or reported risk factors. In Hawai‘i, this means that the over 1.1 million adults and should get tested at least once.
Hepatitis C Affects People Who Inject Drugs, Especially Youth
The CDC recommends HCV testing for all persons who inject drugs. Hawai‘i’s statewide syringe exchange found an HCV antibody positivity of 67% among a representative sample of its participants. There was a noticeable difference in this positivity between younger (under age 30 years) and older PWID, with rates of 31.6% and 90.9%, respectively.
Hepatitis C Affects People Who Are/Were Incarcerated
The CDC recommends universal HCV testing for all adults in correctional settings. The last seroprevalence study in Hawai‘i's prisons estimates HCV prevalence at 24%, or 1 out of every 4 persons who were imprisoned.