Conclusions and Recommendations

Hepatitis C viral infection is a serious blood-borne chronic disease that is rapidly reaching the point of crisis across the country. Because of the latency period and lack of symptoms, many people are completely unaware that they are infected. As Maine’s population ages, more and more cases of clinical illness caused by hepatitis C infection will arise.

The key findings of the Maine Hepatitis C Infection Needs Assessment include the following:

Fewer than 1 in 10 Mainers infected with hepatitis C infection know that they have this life-threatening infection;

Little is going on in Maine to raise public awareness of hepatitis C and to prevent new infections;

Screening tests for hepatitis C infection are not readily made available or accessible to those at highest risk for the infection;

Once tested and found to be infected with hepatitis C, a typical Mainer must find his or her own medical treatment and support resources;

Medical expenditures for patients with hepatitis C infection have skyrocketed in the past three years, with the state’s Medicaid program spending in excess of $10 million in 1999; and

Injection drug users, prison inmates, and HIV/hepatitis C co-infected individuals are all groups of Mainers that, at present, are disproportionately affected by hepatitis C infection and are particularly vulnerable to serious complications.

Based on these findings, the Maine Hepatitis C Infection Needs Assessment Steering Committee recommends the rapid implementation of a comprehensive strategy to prevent and treat hepatitis C infection in Maine. The strategy must include statewide efforts coordinated by the Maine Bureau of Health to immediately address the following six priorities:

1. Increase public awareness of hepatitis C. A wide variety of media should be used to convey clear, accurate messages about hepatitis C infection to the general public, policymakers, and health and human services professionals.

2. Develop and implement an accessible hepatitis C counseling and testing program, which targets those at risk and builds on the existing HIV counseling and testing infrastructure. This can be achieved through education and training of current HIV/STD prevention staff, substance abuse treatment counselors, and prison health staff; providing funding for hepatitis C infection screening and follow-up tests through the Health and Environmental Testing Laboratory; and providing access to free counseling and testing for those at highest risk.

3. Stop the spread of hepatitis C infection through community outreach prevention programs. Community-based health and social service agencies with proven health education track records, particularly with the marginalized in our society, should be funded in a coordinated, statewide hepatitis C infection prevention initiative.

4. Improve the quality of care for persons with hepatitis C infection by providing state-of-the-art continuing education programs and expert consulting services to physicians and other health and social service professionals. An initiative modeled on the AIDS Consultation Service at Maine Medical Center should be established through an inclusive, public-private partnership.

5. Develop and ensure access to an affordable, comprehensive system of care for people with hepatitis C infection including, at a minimum, medical, mental health and substance abuse treatment services. Collaborative efforts to extend and assure coverage for these essential services should be undertaken by public and private insurers in Maine. Models to explore may include current efforts underway in New Mexico as well as Maine’s own Medicaid HIV Waiver.

6. Improve hepatitis C infection surveillance capacity and initiate special studies to increase understanding of the extent and dynamics of hepatitis C infection in Maine. Human resources are needed to refine and extend current HCV infection data gathering and analysis and to communicate the information to health providers and policymakers.

We stand at a critical point in time in Maine in the hepatitis C epidemic--a crossroads of crisis and opportunity.

Continued inaction in the face of the hepatitis C epidemic in Maine will lead us down the road of crisis in the near future. The crisis will manifest itself in new hepatitis C infections that could have been prevented, lost years of life for those unaware they are infected, and increased economic costs to both individuals and society.

Alternatively, we can embrace the challenges presented by the hepatitis C infection epidemic and choose the opportunity to respond to the many needs in new and creative ways. The opportunity we can choose is to construct a unique Maine-specific blend of public-private collaboration to mobilize needed human and financial resources to meet the hepatitis C epidemic head-on. The choice is ours.

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