Impact of Programs to Manage Alaska Native Patients with Chronic Hepatitis B and C in Urban and Remote Rural Areas Using a Data Base Registry

Wednesday, 20 August 2014: 4:30 PM
Boardroom (Dena'ina Center)
Brian J McMahon, MD , Alaska Native Tribal Health Consortium, Anchorage, AK
Lisa R Bulkow, MS , CDC Arctic Investigations Program, Anchorage, AK
Prabhu Gounder, MD , Centers for Disease Control and Prevention, Anchorage, AK
Lisa Townshend, BS , Alaska Native Tribal Health Consortium, Anchorage, AK
Susan Negus, BS , Alaska Native Tribal Health Consortium, Anchorage, AK
Mary Snowball, BS , Alaska Native Tribal Health Consortium, Anchorage, AK
Chriss Homan, BS , Alaska Native Tribal Health Consortium, Anchorage, AK
Brenna C Simons, PhD , Alaska Native Tribal Health Consortium, Anchorage, AK
Stephen Livingston, MD , ANTHC, Anchorage, AK
Introduction: Over 600 million persons globally are estimated be infected with hepatitis B virus (HBV) or hepatitis C virus (HCV). Alaska Native Persons have high rates of both HCV and HBV; most with HBV infection live in isolated rural communities not connected to the road system making management of these infections challenging.

Methods: We have developed Alaska Statewide Computerized Registries to aid management of hepatitis B since 1982 and hepatitis C since 2000. All persons with HBV (1560) and  HCV (1323) infections receive letters every 6 months reminding them to go to their village clinic or hospital for blood draw for liver function (LFT) and alpha-fetoprotein testing (AFP). Sera are sent to the Alaska Native Medical Center for testing and review.  For HBV infection, persons with AFP > 10 mg/ml are referred to the nearest facility for liver ultrasound (US); persons with elevated LFT have HBV DNA testing performed and if both LFT and HBV DNA are elevated, they are evaluated for liver biopsy and potential treatment.

Results: Since the year 1982-2013, 1367 persons with HBV infection have had 40,385 laboratory visits that yielded 53 cases of hepatocellular carcinoma. Sixty-eight percent of tumors were found at a resectable stage and 5-year survival was significantly better than historical controls (40% vs 0; p=.0.012). In addition, 102 patients with HBV infection were started on antiviral therapy. For patients with HCV infection, 176 received antiviral therapy and 92 experienced a sustained virologic response (SVR). The advent of new drugs for hepatitis C will make it easier to treat and cure persons living in rural areas.

Conclusions: This program demonstrates that care and treatment of hepatitis B and C as recommended by evidenced-based Practice Guidelines can be carried out for infected persons living in both urban and isolated communities via electronic based registries.