Abstract
Purpose: The purpose of this project was to develop a comprehensive hepatitis C program in a rural Native American clinic in which no concrete screening or monitoring protocol exists.|Background: In the United States, approximately 3.9 million individuals are living with a hepatitis C virus (HCV) infection that causes chronic liver disease. Most infected individuals are unaware they are infected and therefore do not participate in monitoring or follow up care. The Native-American population has a four times greater proportion of deaths caused by chronic liver disease than the overall United States population.|Methods: On a rural Native American reservation clinic, an increased screening protocol was implemented. Once identified, HCV positive individuals were enrolled in the monitoring program which provided education and evaluated alcohol abuse, depression, liver disease progression, and screening for hepatocellular carcinoma (HCC).|Results: A total of 46 individuals were screened with the HCV antibody testing, compared to 33 screenings completed three months prior to the project initiation. There were two new HCV diagnoses discovered during this screening period. There were a total of thirty HCV individuals out of 2016 (1.4%) active adult patients in the clinical system were identified as HCV positive. The most prominent age cohort with the HCV infection was ages 29-39 (3.0%). There was a 50% (15/30) compliance rate with completing the HCV monitoring portion of the project. Of those individuals monitored, alcohol abuse screening was positive in 53% (8/15), depression screening was positive in 33% (5/15), liver disease screening demonstrated 26% (4/15) had significantly elevated serum liver function tests and HCC screening was positive in 13% (2/15) which warranted liver ultrasound testing.|Conclusions: Increased HCV screening is appropriate in this high risk population to facilitate early detection, subsequent education, and medical monitoring of these individuals. Efforts to increase compliance of monitoring in HCV positive individuals are valuable to their health outcomes.