NATAP Report and Plea (part 2)

5. Provider Education: One of the major factors contributing to missed diagnoses of chronic viral
hepatitis is the lack of health care provider awareness and education. Education would increase
routine screening and testing of patients which should be offered independent of perceived risk
factors, and support implementation of universal evidence-based management guidelines.

6. Medical Care Services: All patients with chronic viral hepatitis should be considered as candidates
for therapy. No arbitrary exclusionary qualifications (e.g., race, ethnicity, gender, language,
insurance status, active substance use, homelessness) should be allowed to substitute for the
judgment of patients and their health care providers. These services must include primary medical
care and access to specialty care.

7. Mental Health and Substance Abuse Care: Due to the very high rates of comorbid mental health
and substance abuse issues faced by these patients, especially those with HCV, access to
comprehensive mental health and substance abuse services are essential to providing the standard
of care.

8. Laboratory and Diagnostics: Lack of accessible hepatitis B and C testing contributes to missed
diagnoses, misdiagnoses, missed treatment opportunities, and mismanagement of patients on
treatment. Wider availability of and reimbursement for HBV and HCV virus testing to confirm
chronic infection following a positive test is urgently needed. All available diagnostic and prognostic
tests must be available and reimbursed at the point of care.

9. Formulary: In all phases of pretreatment, treatment and follow up, patients should have access to
all drugs necessary for the successful treatment of HBV and HCV (and side-effects associated with
HCV treatments) and related co-morbidities and co-infections.

10. Chronic Viral Hepatitis Guidelines: The Department of Health and Human Services (DHHS) and the
American Association for the Study of Liver Diseases (AASLD) should coordinate a process similar to
the panel that develops and regularly updates the Guidelines for the Use of Antiretroviral Agents in
HIV infected Adults and Adolescents. Public and private health plans should be required to follow
existing CDC guidelines for viral hepatitis screening; the CDC’s Advisory Committee on Immunization
Practices (ACIP) guidelines for viral hepatitis immunization of infants and adults; and the National
Institutes of Health (NIH) guidelines for chronic viral hepatitis management and care.

We hope you will address these key issues as you construct health reform legislation.
This principles document was created by a committee convened by the National Viral Hepatitis
Roundtable. The National Viral Hepatitis Roundtable is a coalition of public, private, and voluntary
organizations dedicated to reducing the incidence of infection, morbidity, and mortality from viral
hepatitis in the United States through strategic planning, leadership, coordination, advocacy, and
research. For additional information, please contact Martha Saly, Director, at 707.480.0596 or at
***@****.

The following organizations endorse the National Viral Hepatitis Roundtable’s Chronic Viral Hepatitis and
Health Care Reform and Chronic Viral Hepatitis Prevention Principles statements. The full documents are
available at http://www.nvhr.org.


Sincerely,

Martha Saly

Director

National Viral Hepatitis Roundtable (NVHR), Decatur, GA

[lalapple]

many people are unaware of what goes on with hcv in today's society, approximately 2.7 million individuals in America with hcv are not aware they have the virus.