Hepatitis C, A Public Health Threat In Butte County
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Hepatitis C is a viral disease, which is usually asymptomatic until, after a while, it degrades the liver from persistent (chronic) infection, usually after 20-30 years. The HCV virus is spread through infected fluids, and most commonly is acquired through the use of contaminated needles, followed by unprotected sex (5). In fact, 80% of those infected will develop chronic liver disease and 40-60% of all chronic liver diseases are related to Hepatitis C (5). Thus, the high levels of Hepatitis C pose a serious threat within Butte County, which consistently has over 300 reported cases every year when only 2% of the U.S (3.9 million people), on average, are infected with Hepatitis C (4). In 2010, Butte County had a population of about 200,000 but it has reported that about 4,000 people have been tested positive for Hepatitis C without including the homeless and those incarcerated within that given year (4). Moreover, Butte County’s death rate from liver disease is 50% more than California’s as a whole and 5 times as much as the national health objectives goal (4). While there are no really statistics on how many cases are drug users, it is assumed most new cases stem from that since 80% of those who share drug needles are likely to get infected (6). All of this is exacerbated when considering that Hepatitis C is difficult to track, given that no symptoms are encouraging screening and reporting, and does not have a vaccine. Prevention without vaccine is the only option.

Rural Butte County will have a tough time with that as it is in a low economic status area, and thus has less resources and funding for healthcare programs. At the same time government programs such as Medicare and the Affordable Care Act have increased the number of patients, adding to the workload of the local health clinics while not necessarily adding funding (2). In addition to this stress on the healthcare system, Butte County has a large number of drug users, with 58% of arrests in 2012 involving methamphetamine abuse (3).

In the interest of mitigating the spread of Hepatitis C, one must address the sharing of unsanitary used needles among drug users. While drug users have been known for risky behavior in their quest for gratification (getting high), we can hope to use their concern for health and incentives to change this. It is also hoped that an increase in awareness throughout the community can prevent people from not knowing the dangers and discourage people, particularly drug users since they are at high risk, from not taking it seriously or ignoring the issue. After all, Danny Jenkins, who has worked at Butte County, has mentioned he “was shocked to find out [he] had been living with this for so long” (1), showing how easy it Is to be unaware. Also, healthcare professionals are key tools who see the cases personally, and would be willing to work to help. As Oroville Clinic mentioned in an interview that they “do what they can for the cases they find” (7).

Taking all of this into account, a great solution would be to start a needle exchange program in Butte County. The distribution of clean needles to drug users in place of dirty needles prevents unsanitary needles from being shared interpersonally between drug users. The hospitals or city maintenance department can support this by providing collection areas and giving incentives (like a small cash payout) in addition to clean needles to motivate people to bring dirty needles in. In all, the availability of needles and simultaneous decrease of dirty needles will greatly lower the likelihood that users will be using an infected needle. In terms of effectiveness, this solution can be very effective since dirty needles is a known major cause of infection, especially here where a lot of drug users are. By lowering the transmission rates, his will help contain Hepatitis C to people who currently have it. It is also somewhat inexpensive. Although the cost of needles and syringes are not cheap, but the prevention of many cases of Hepatitis means less treatment costs with less people infected, preventing the spending of money people may not have. It is greatly decentralized, as the distribution of needles can happen in multiple parts of town, especially parts where drugs are more prominent. There doesn't need to be multiple sites of distribution, but selected dealers and users may collect dirty needles, exchange them, and then sell the clean ones. Moreover, this is flexible, since it can address many problems within the target group. It will work with multiple types of drugs and in multiple neighborhoods and cities within the county, and works with the changing flow of drug users using needles.

However, this plan could be more sustainable. Most dirty syringes and needles need to be shipped off to a special lab where they are able to autoclave and sterilize the needs again, which takes transportation and running costs. It may be worth is still because it is so very simple. People bring in dirty needles and get replaced clean ones, taking the dirty needles out of circulation. It is also highly compatible, as the drug users can plan to exchange needles any time and aren’t really required to do anything much different other than use a clean needle.

In the end, locally, locally, Butte County health organizations/institutions (e.g. clinics) and the city health department or recycling/maintenance department can work together to provide the program. Specifically, the city can try to allocate funding for this program and/or simply provide the recycling mechanism for the needles, as we already know they deal with trash for the city, which may also contain needles. The health organizations can use their knowledge of healthcare equipment costs to get needles cheaply and provide the workers/setting for performing the needle exchange. This exchange program will made clean needles readily available. With cleaner needles they won't be as tempted or need to share needles or use dirty ones. This will lower the rate of transmission between people because they aren't sharing as many needles. They will want to avoid getting sick and if there are clean needles available they are more inclined to use them, and the participation will show how much the program is working. The community could get really involved too, and start a fundraising campaign in cooperation with local hospitals and research centers. So long as this is undertaken with enthusiasm, the problem can get better.

References:

1. “CalHEP Member Profile: Danny Jenkins.” (2012). California Hepatitis Alliance. Retrieved from: calhep/pdf/LA_Hep_C_Task_Force_Danny_Jenkins_2011

2. Cameron, K. (2013, July 19). Primary care physician is in Butte County and nationwide. The Chico Enterprise-Record. Retrieved from chicoer/ci_23698013/primary-care-physician-shortage-is-butte-county-and

3. Carpizo, A. (2013, August 13). “Heroin abuse on the rise in Butte County, nationwide.” The Chico Enterprise-Record. Retrieved from: chicoer/news/ci_23849956/heroin-abuse-rise-butte-county-nationwide

4. “County Health Status Profile”(2008). Butte County Public Health Site. Retrieved from: buttecounty/publichealth/cder/disease_stats_profiles2008.pdf

5. “Hepatitis C.” (2013, May 6). The Center for Disease Control and Prevention (CDC). Retrieved from: cdc/hepatitis/C/index

6. “Hepatitis C.” (2013, November). Illinois State Public Health Department.

Retrieved from: idph.state/public/hb/hbhepc

7. “Questions About Hepatitis C.” (2013, November). Oroville Clinic. Retrieved from a short personal interview.


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