The Partisan Divide on Health Care

1945 and 1965 had been screened for hepatitis C, with 7400 new infections identified nationwide in 2015 alone. Morgan’s region is one of several across the country that have created hepatitis C dashboards featuring information from patients’ electronic medical records that is updated daily. The tool allows Morgan and colleagues to sort through patients by hepatitis C genotype, extent of liver disease, treatment status, and other factors. Last year, the Long Beach VA system used it to identify veterans with hepatitis C and advanced liver disease who hadn’t yet been treated and send a letter inviting these veterans to come in for potentially curative therapy. “If they don’t call, we call them,” Morgan said. During the previous 2 years, nearly 40% of veterans treated for hepatitis C at the Long Beach medical center had been diagnosed with advanced liver disease. Nationally, that figure is 21% of the 174 842 veterans within the VA health system who have been diagnosed with hepatitis C. More than 76 000 of these veterans have already received treatment, and more than 60 000 have been cured. Educating Veterans Once veterans are in treatment, managing their need for ongoing monitoring and education about hepatitis C is yet another challenge. In San Francisco, a solution is monthly group visits, where 4 to 8 veterans have their blood drawn, pick up a 30-day supply of medication, talk about their latest test results, and provide each other with peer support. A psychologist is typically present to deal with emotional issues that accompany treatment and hope for a cure. Veterans with drug or alcohol addiction aren’t automatically excluded from treatment at the VA, nor is there any specified abstinence requirement. But they won’t be offered antiviral therapy if adherence problems are suspected, Ross said. The VA has extensive experience in treating veterans with HIV infection who also struggle with substance abuse, and the agency understands the need to address social and psychological issues that can complicate medical treatment, he noted. As many as 1 of 10 Vietnam veterans have chronic hepatitis C—a rate 5 times that of the general population—and Vietnam Veterans of America has begun holding educational sessions around the country to encourage them to get tested and seek care if necessary. All are in the age group the VA is targeting, but the hepatitis C virus wasn’t identified until 1989, years after the war ended. Meanwhile, the American Legion has also begun testing veterans for hepatitis C at community events through a partnership with AbbVie, which markets the Viekira Pak hepatitis C medication and has a financial interest in seeing more veterans treated for the disease. Addressing the stigma associated with hepatitis C—which is closely associated with injection drug use and found disproportionately in people who are homeless and other marginalized populations—is an important part of these discussions. “When they came home, Vietnam vets were widely viewed as drug addicts or lazy good-for-nothings, and they haven’t forgotten,” said Berger. “Most of us were not involved in IV drug use; that’s not how we acquired hepatitis C. But that’s one of the reasons why so many of our people don’t get tested, because of the stigma.”