Turning the Tide: Seeking Community-based Solutions to a Public Health Challenge
Hepatitis C – a viral infection that affects the liver and is spread by contact with infected blood – is one of the leading causes of liver cancer. Though the virus can be cured with oral drugs, the number of people infected with hepatitis C in Wisconsin is on the rise, largely because of the increase in opioid drug abuse.
For Dr. Ryan Westergaard, solving this public health problem means developing new approaches to make sure people with hepatitis C get the care and resources they need.
“We’re focused on reaching individuals who are not engaged in healthcare and who are at the highest risk of getting viral hepatitis, who are at risk of premature death related to opioid overdose.”
Westergaard, MD, PhD, is an associate professor of medicine at UW-Madison and the Chief Medical Officer for the Bureau of Communicable Diseases within the Wisconsin Department of Health Services. He joined the UW Carbone Cancer Center in 2017. He and his collaborators have been working with local communities to identify the best ways to reach the people most at risk for contracting and spreading hepatitis C and other bloodborne infections.
“We have a community engaged research project that recruits people who inject drugs and then tests them for HIV and viral hepatitis and inventories their met and unmet healthcare needs,” says Westergaard. “We’ve been doing this for the past two years to characterize community level risk for infectious diseases and drug overdose.”
From these studies, Westergaard’s team has identified and designed an intervention program that is inspired by a model originally developed for cancer patients – patient navigation. In this system, cancer patients receive personalized help to navigate complex treatment options, obstacles to receiving care, and any social or support needs. A new program targeted for people with substance abuse disorders will provide many of the same services but will instead operate in community organizations rather than traditional healthcare settings.
“We’re embedding ‘prevention navigators’ in syringe service programs, which are community-based organizations operated by the AIDS Resource Center of Wisconsin,” says Westergaard. “These navigators will be trained to help people struggling with substance abuse disorders who are currently outside the healthcare system. They may help get people enrolled in health insurance, or let them know how to get connected to treatment for hepatitis C. If they don’t have hepatitis C, then the navigator can help make sure they know how to prevent getting hepatitis C.”
In early 2020, Westergaard and his collaborators will launch a pilot program in three Wisconsin communities to test if their prevention navigation program supports more effective drug abuse recovery and disease treatment.
For Westergaard, providing these services through local community organizations is the key to reaching people with substance abuse disorders and slowing the spread of hepatitis C and other preventable diseases.
“Community organizations, and needle exchange programs in particular, have for decades been developing the trust and rapport of a group of people that generally feels excluded from the health care system. They are able to engage with people with substantial health needs in ways that UW Health, for example, cannot,” says Westergaard. “Community organizations serving people who inject drugs provide essential services that are free, anonymous, and delivered in a non-judgmental and non-stigmatizing environment. We realized these are the key ingredients for successfully connecting with folks who are at the highest risk of HIV, hepatitis C and opioid overdose, and therefore the ideal setting for a new prevention navigation program.”
A community-based prevention navigation program is one piece of a larger effort to prevent further viral hepatitis C infections, and Westergaard believes that with the help of other disease prevention tools, including more effective medications and policy changes, making real progress with this disease is possible.
“We have an opportunity to turn the tide on an epidemic that’s currently going in the wrong direction,” Westergaard says.
Date Published: 09/06/2019