A Systematic Review of Newly Implemented Hepatitis C Public Health Policies in the United States: To Inform Policy Efforts to Control Hepatitis C in China

Background and Purpose: Globally, nearly 185 million are living with hepatitis C virus (HCV)—a leading cause of advanced liver disease. China alone (25 million) has more HCV-infected persons than Europe, and North and South America combined. Unfortunately, the majority of HCV-infected persons in China are unaware of their HCV infection. Although the number of HCV cases in China are six-fold higher than the United States, the epidemiology of HCV and the public health burden of HCV are quite similar in both countries. Among countries heavily burdened with HCV, in 2012 United States federal public health agencies were among the first to implement novel public health policies to combat HCV. An understanding of these public health policies may be of use to public health social workers in China. The purpose of this systematic review was to identify newly implemented public health policies designed to control HCV in the United States, and to discuss the potential benefit of similar policy adaptions by public health policymakers in China.

Methods: This systematic review was conducted using the PRISMA Statement guidelines. PubMed and MEDLINE databases were searched from 2012 to 2015 using Boolean operators in combination with the following key words: hepatitis C, HCV, recommendation, and policy. The search strategy generated 62 citations across PubMed and MEDLINE. Thereafter, citation titles were reviewed for duplications leaving 33 potential citations. To limit the focus on HCV policy, articles published by the following federal agencies were included and reviewed: the Centers for Disease Control and Prevention (CDC), the US Preventive Services Task Force (USPSTF), and the US Department of Health and Human Services (HHS).

Results: In 2012, the CDC expanded HCV testing policies to include birth-cohort (baby boomer) testing for all persons born between 1945-1965. The purpose of birth-cohort testing is to identify unrecognized cases of HCV among populations with the highest HCV prevalence. To facilitate birth-cohort testing, in 2013 the USPSTF augmented the HCV testing policy from grade C to grade B; thus, restricting medical insurance from charging copays and copayments to patients for HCV testing. Likewise, HHS appropriated federal funds for implementation of a national community-level campaign, known as Know More Hepatitis, to increase HCV awareness in the general population, among medical providers, and healthcare systems.      

Conclusion and Implications: It is plausible adaptation of novel public health policies in China could enhance HCV awareness, access to care, and linkage to care and treatment. Public health social workers in the United States play key roles in dissemination and implementation of the latest HCV policies in public health and medical settings. Though there are structural and governmental differences between the United States and China, public health social workers in China can advocate for universal HCV testing, testing coverage, and  awareness campaigns combat HCV—particularly for vulnerable and underserved populations in China. Global reductions in HCV morbidity and mortality cannot be realized without the advent of novel public health policies in China.