Hartford public health officials say they are concerned with new data on Hepatitis C in the city. The numbers show ten to 20 cases a month of people newly-diagnosed with a chronic form of the disease. The city is using computer mapping to help it better target, test, and treat its residents.
William Lowe is standing outside a homeless shelter near the city's Coltsville area, waiting for his turn in a mobile health van. He says he wound up homeless because a joint disease forced him to drop out of community college, lose his job, and pretty much lose everything else.
He's here now to get himself tested for HIV and Hepatitis C. He wants his partner to know he's got a clean bill of health. "Because I'm not going to always be homeless. If you tell somebody you was homeless, it's a stigma that comes with that and I have to be able to give them a clear set of mind. Because I'm going to be asking questions when I go into a relationship, too...You got to know who you're dealing with and I'm willing to tell people my history. And I'm willing to show them my history, man, because it's serious."
When he steps into the R.V., a city health department employee awaits him with some questions and a couple finger pricks. One for HIV, one for Hepatitis C. The latter is brand new.
Over the past couple of months, the city, with the state's permission and equipment, has begun what is called rapid testing -- the kind of diagnostic work that can give a result in 20 minutes. Raul Pino is the city's health director. Standing outside the van, he says the city uses the data to help treat people with the disease.
But he also uses the data to help him better focus the limited resources of his small staff. "It really plays a role in, again, targeting the areas and the individuals and the behaviors that more likely are to play a role in the transmission of the disease -- and, also, help to demonstrate to funders that you have the ability to intervene on the micro level where this is happening."
Hepatitis C is a blood-borne disease and is commonly transmitted by IV drug users sharing needles. It can take years to manifest itself. Pino says what the city is seeing now are the after effects of high rates of IV drug use in the Latino community in the late 1980s and early 1990s. According to public health officials, there were 219 newly diagnosed chronic cases of Hepatitis C in the city between May 2011 and July 2012. Two thirds of the cases are men and most of the over the age of 40. For those who reported their race and ethnicity, Hispanics were most likely to test positive in just a few neighborhoods.
Pino says the testing is valuable because you can't take care of yourself if you don't know you're sick. "You need to know that you have it to be able to take care of yourself. And prevent a healthy lifestyle that is conducive to a healthy life and a healthy outcome. Because a high percentage of these individuals may end up with a liver transplant. So, it's a serious disease."
Recently, the federal Centers for Disease Control came out with a new recommendation that all baby boomers receive a one-time Hepatitis C test. The CDC says that increased testing could identity more than 800,000 people with the disease -- and that expanded testing could save 120,000 lives. State data from 2010 shows the highest concentrations of Hepatitis C in the state's population centers. That's also where it's expanding its rapid testing, like it's doing in Hartford.
Carol Steinke is a public health nursing supervisor for the city of Hartford. She says that the new data the city is getting from the state helps her and her small staff to do immediate outreach by phone. "Did they know they had Hep C? Do they have follow up, are they in care, what their risk factors were. Ask them about, do you know how you obtained Hep C? Have you had your vaccines for Hepatitis A and B to protect your liver, that kind of thing. Making sure they're linked into care, if they're not, then we'll go ahead and give them a list of referrals of folks that do see folks with Hepatitis C."
Steinke says she doesn't just see one-time IV drug users. She also sees diabetics. "That does happen a lot. We see people, they're sharing medications, because, again, the cost of medications, a lot of folks don't have insurance, they'll share each others glucometers to check their sugar, they might be using the same lancet versus changing it each time to check their blood sugars. Share needles, share medications, we see that a lot." Steinke says the thing that would help her the most would be more money to pay more people. "We have limited resources. So that's why the mapping and identifying where our cases are is helpful for us to direct our intervention."
Back at the van outside the McKinney Shelter, William Lowe walked out with the news he was hoping for. His Hep C test was negative. And so was his test for HIV. "So, this is a gift, man. I consider myself a special commodity. So, I'm in a shelter, but I got something to be thankful for."