The road to a hepatitis-free future

A new California bill is taking action to bridge disparities in testing and treatment for the liver diseases hepatitis B and C. 

Hepatitis refers to the inflammation, or swelling of the liver. It is primarily caused by viral infections, but it can also be caused by lifestyle or genetic factors such as heavy alcohol/drug use, obesity and autoimmune disorders. 

Both hepatitis B and C are forms of viral hepatitis caused by the hepatitis B virus and hepatitis C virus, respectively. These two types of viral hepatitis are of particular concern because they are the most common causes of chronic liver disease, cirrhosis and liver cancer.

Fortunately, hepatitis B and C can be prevented through measures such as getting vaccinated and practicing proper hygiene. There are also antiviral medications available that can help treat hepatitis B and C, especially if they are diagnosed early on.

However, hepatitis B and C are known as the “silent killers” because in many cases, by the time symptoms appear and the disease is diagnosed, the infection has already caused severe liver damage and it is too late for treatment to be effective. 

Despite recent advancements in the development of treatments and vaccines, chronic hepatitis B and C remains a serious public health issue in California. About 624,000 adults in California have chronic hepatitis B or C, which is more than any other state. 

Minority populations are also being affected by hepatitis B and C at disproportionately high rates due to factors such as lack of health awareness, historically low immunization rates and limited access to healthcare services.

A 2018 study found that members of the Asian Pacific Islander community made up 88% of all chronic hepatitis B cases in California. According to the Office of Minority Health, compared to non-Hispanic white Americans, Hispanic Americans were 70% more likely to die from viral hepatitis; Asian Pacific Islanders were 8x more likely to die from hepatitis B; Black Americans were 2.6x more likely to die from hepatitis C; American Indians and Native Alaskans were 2.7x more likely to die from hepatitis C. 

Recommended by the Centers for Disease Control and Prevention, US Preventive Services Task Force and American Association for the Study of Liver Diseases, screening and treatment can prevent most of the complications and deaths caused by hepatitis B and C.

Routine hepatitis B and C screening are currently covered by the Affordable Care Act, Medicare and Medicaid; however, according to the U.S. Department of Health and Human Services, only one-third of hepatitis B and 60% of hepatitis C positive individuals are aware of their infection.

In addition, the CDC estimates that only 36% of people diagnosed with hepatitis B and 45% of people diagnosed with hepatitis C are connected to care and treatment to prevent end-stage liver disease or cancer.

That’s where AB789, a recent bill in California, comes in.

First introduced by Assemblyman Evan Low from the API caucus and Assemblyman Mike Gipson from the Black caucus in early February, this bill was written to address gaps in testing and treatment for hepatitis B and C. To accomplish these goals, this bill will require California health facilities and clinics that provide outpatient primary care services to: 1) offer voluntary screening for hepatitis B and C and 2) provide persons tested positive with follow-up health care and treatment or offer referral for care and treatment (with certain exceptions).

According to a study by the National Academies of Sciences, Engineering and Medicine, hepatitis screenings are extremely cost-effective — while many of these screening tests cost as little as $10, they have the potential to save millions of lives as well as millions of dollars in healthcare costs. As such, by promoting screening and early detection, not only will this bill help combat health inequities and prevent many more people from dying of chronic hepatitis B and C, but it will also save California taxpayer dollars.

The bill, which is co-sponsored by the Health Trust and State Treasurer Fiona Ma, was created in collaboration with the Asian Liver Center at Stanford University as the subject matter expert. This bill was unanimously passed by the Assembly Health Committee last month and is now in the Assembly Appropriations Committee, which reviews bills with a fiscal impact.

Passage of the bill — co-authored by Assemblymember David Chiu (D-San Francisco) — would make California the first state in the country to require health facilities to offer voluntary hepatitis B and C testing.

Reducing deaths and new infections from viral hepatitis were named one of the six winnable battles in public health by the CDC in 2018. May is also National Hepatitis Awareness Month, with Hepatitis Testing Day falling on May 19.

Through initiatives like the bill described above and the inclusion of hepatitis in national public health advocacy efforts, many organizations and experts across the United States are working toward the next steps on the long journey to a hepatitis-free future.