According to
the Polaris Observatory estimates just over half of people with hepatitis C in
the United States are aware of their infection. Although rates of diagnosis are
high in New York state (81%) and California (71%), other states are doing less
well, and the United States is also experiencing a sharp increase in new
hepatitis C infections in young adults and adolescents as a result of sharing
of injecting equipment.

In 2015, the
USA treated around 256,000 patients and some 230,000 in 2016. Polaris’s latest
projections suggest that without new initiatives to boost treatment and
diagnosis rates the annual number treated across the USA will fall to just
130,000 per year by 2020. To reach the WHO 2030 elimination target, treatment levels
must be sustained at 250,000 per year leading up to 2030. The USA is also
unlikely to meet the targets set out in its own national plan, some of which
are even more ambitious – such as a 60% fall in both hepatitis B and hepatitis
C new infections by 2020.  

In two thirds
of states, treatment on Medicaid programs has been restricted to people with
advanced disease, preventing treatment access for those without private
insurance. However, the outlook is not entirely bleak — recent developments
have meant the approval of new and cheaper hepatitis C drugs, which can be used
to treat all types of the virus (genotypes 1-6), requiring just 8 weeks of
treatment to achieve cure.

These lower
prices are allowing states such as Delaware, which previously restricted
treatment to the sickest patients, to open up Medicaid coverage to all
hepatitis C patients from January 2018. Delaware joins 16 other states
(including Alaska and Georgia) that will open up restrictions (or never had
them).

At the recent
Liver Meeting in Washington, DC (October 28) all states and Puerto Rico were
graded on how easy it is to obtain Medicaid treatment for hepatitis C. States
receiving the best grade of A were Alaska, Connecticut, Massachusetts, Nevada,
and Washington. States that received an “F”, the worst grade, were Arkansas,
Louisiana, Montana, Oregon, and South Dakota.