A new case of hepatitis C was reported nearly every eight hours in Kanawha County last year.
The number of men and women diagnosed in 2018 with the infectious disease soared in the months after the Kanawha-Charleston Health Department closed its public syringe exchange earlier that same year.
Hepatitis C, a virus that can lead to liver cancer or early death if left untreated, is commonly contracted through sharing needles.
New data from the West Virginia Department of Health and Human Resources revealed 1,114 newly reported chronic hepatitis C cases in 2018. It’s the highest number of chronic hepatitis C cases reported in the past five years in West Virginia’s largest county.
“Everyone understands we have a problem, but no one understands just how big the problem is,” said Dr. Letitia Tierney, director of the hepatitis C clinic for Cabin Creek Health Systems.
Tierney emphasized that the area is nearing a hepatitis C outbreak and a potential HIV outbreak, as both viruses can be shared through needles.
Two new HIV cases were confirmed in Kanawha County this summer, according to Angie Settle, executive director of West Virginia Health Right. The nonprofit clinic tested 1,550 “high risk individuals.”
The DHHR did not provide its HIV numbers by Monday’s press time.
“We have a very narrow window of opportunity here to make a significant change,” Tierney said.
The Kanawha-Charleston Health Department has no plans to revive its free needle exchange program, according to Janet Briscoe, KCHD director of epidemiology.
Briscoe said the new chronic hepatitis C cases likely could include residents who had the disease long before it was diagnosed in 2018.
She noted that the majority of the cases in Kanawha County, which included 41 acute cases in 2018, were linked to sharing needles.
In 2017, two years after the KCHD opened its free syringe exchange in Charleston, the DHHR reported hepatitis C numbers in the county had reduced to 458 chronic cases — the lowest number since 2012.
The KCHD suspended its program in March 2018 after Charleston Police Chief Steve Cooper, who has since retired, created a list of regulations that included requiring a government-issued ID to access a clean syringe.
Cooper and first responders had expressed concern over increased needle litter in the city and nondrug users coming into contact with used needles.
Dr. Michael Brumage, former director of the KCHD who oversaw the needle exchange, said he wasn’t surprised that the number of confirmed chronic hepatitis C cases had more than doubled since the program’s closure.
“The only controversy here is a social one,” said Brumage, who is now medical director for Cabin Creek Health Systems. “If we fail to address this, the results are predictable and avoidable.
“When people don’t have access to adequate numbers of clean syringes, they will share the syringes.”
Health Right operates a limited syringe exchange program through its clinic. Settle would not give specifics on its program’s rules.
Joe Solomon, an outreach worker who checks on IV drug users in Charleston, said many of the people he meets are unaware of Health Right’s program.
Hep C unlikely to stay in drug-use population
Dawn, a 45-year-old woman in Charleston whose full name is not being used to protect her identity, started injecting methamphetamines six months ago. She shared a needle with an ex-boyfriend. She was recently diagnosed with hepatitis C.
“I knew it was a possibility, but I was one of those who thought it will never happen to me,” she said.
Dawn, who is homeless, has shared needles with other users since her diagnosis.
She explained that using meth has been “an escape” from sleeping on the streets and hunger. She regularly injected meth, or ice as she called it, late at night to help her stay awake and guard her belongings.
Needles can be hard to come by, she said, and that leads people to share with confidants or strangers.
A pack of syringes can run from around $5 to $10 at local drug stores, if the store carries them.
Health Right requires a one-for-one exchange, and homeless people often are unable to return the complete amount for an even exchange because of stolen or lost needles.
“We reuse the needles until they can’t be used,” Dawn said.
Dr. Robin Pollini is an infectious-disease epidemiologist at West Virginia University who has focused her research on people using drugs. She listed factors that most commonly contribute to needle sharing: homelessness, a lack of accessible unused needles and fear of arrest for having a needle.
“The ideal, from the public health perspective, is that you have a new, sterile exchange every time you inject,” Pollini said.
Brumage said hepatitis C is unlikely to be contained within communities of intravenous drug users.
“These diseases almost never stay in the high-risk group but are transmitted to people who do not use drugs through intimate contact, including sexual contact,” he said.
Tierney, who screens and treats patients for hepatitis C, said she “identified a number of patients who were hep C positive who have not used drugs a day in their life.”
The blood-borne virus, she said, can be passed through using someone else’s razor, finger nail clippers or toothbrush.
Medicaid means hep C treatment barriers
Hepatitis C is treatable, and medication is about $30,000 for a 12-week course, according to Tierney. Patients using Medicaid won’t pay for the treatment — just the copay — but those with limited income using the insurer face treatment barriers.
Hepatitis C, when untreated, can lead to an even more costly liver transplant.
Medicaid requires its hepatitis C patients to be sober from drugs or alcohol for three months before getting treatment.
Also, there is a limited number of doctors in West Virginia who can treat hepatitis C, Tierney said. And at this time, health providers like Tierney, who have years of experience treating the virus, are required to have a group of health providers sign off on treating a hepatitis C patient using Medicaid.
“I have been treating patients for three-and-a-half or four years, and I have only been able to get around 20 patients through Medicaid. But, we’ve got hundreds of patients with hep C,” she said. “It really slows down the process.
State Medicaid officials last week announced that they would be changing regulations for hepatitis C treatment, which include modifying a “specialist consultation” requirement to allow online consultations.
The change is “to take into account the fact that some areas of the state have limited availability of such specialists,” according to Dr. James Becker, West Virginia’s medical director of Medicaid under the DHHR.
The new standards also opens up treatment to Medicaid patients who have earlier signs of liver scarring, which is measured through what’s known as a fibrosis score.
“It’s a positive change,” Tierney said. “It was unconscionable to me that I had to tell people, because they were poor, that they couldn’t get treatment.”
Health department focuses on testing
Briscoe said the KCHD will continue to work with community partners to screen for hepatitis C.
“As long as we have injection drug use, we’re going to see this,” she said.
Six West Virginia organizations, including Cabin Creek Health Systems, this week received more than $900,000 from HepConnect to combat rising hepatitis C infections linked to the drug epidemic.
Pollini cautioned that programs like Health Right or other outreach programs that screen for hepatitis C reach only “a very specific subset of the drug-using population.”
And, she emphasized, the county could be missing opportunities to screen for HIV.
“Generally, those people are marginalized from the health care system,” she said. “They’re generally not people who are going to show up to a public health event.
“I have a great deal of concern for HIV in Kanawha County, particularly because of its proximity to Cabell County.”
Cabell County has a rising HIV cluster of 80 confirmed cases. The cases have been attributed mostly to the county’s intravenous drug users, many of whom are homeless.
“We are on the cusp of an outbreak. There’s already an outbreak in Huntington,” Tierney said. “We have to look at the evidence and have a reasonable discussion about a way we can legitimately make a difference.”