HCV particles are nubby-looking balls of genetic material and protein only 50 nanometers wide—2,000 together would fit in a hair’s breadth. Though mystery continues to surround much of the virus’ activities, it’s believed that it causes damage partly by hijacking the body’s normal immune response, causing fibrous scarring, or cirrhosis, of the liver. Since the liver’s work is integral to so many bodily functions, including filtration of waste products from the blood and production of certain proteins and hormones, symptoms of liver disease range from skin rashes to accumulation of large amounts of fluid in the abdomen. Classic symptoms include jaundice, evidenced by yellowing of the skin or eyes, as well as a lack of energy. Cirrhosis can also lead to liver cancer, which is inoperable in 80-90 percent of cases, according to the National Cancer Institute, and typically kills the patient in three to six months. Unlike cousin strains hepatitis A and B, there is currently no vaccine for HCV.
Compared to the average American, New Mexicans are twice as likely to die of chronic liver disease caused by HCV and alcoholism, which work synergistically to disable the liver. A 2009 Department of Health epidemiology report found that chronic liver disease deaths nationwide decreased by 14 percent between 1981 and 2004 while, during the same period in New Mexico, deaths from chronic liver disease increased by 30 percent. However, deaths due to other infectious diseases decreased in the state during the same period.
Nationwide, HCV levels in prison settings are much higher than levels in the general populations of those prisons’ respective communities. A 2008 study in the journal Hepatology cited a range of 12-31 percent of prisoners in most states as infected, compared to approximately 1.5 percent of the general US population. In New Mexico, the DOH estimates the state prison system infection rate at more than 40 percent—and that data is taken from when the prisoners initially enter the facilities. According to Caleb Alarid, a peer educator who taught HCV prevention tactics to inmates, an estimated 80 percent of inmates have the disease by the time they’re released.
“[Inmates], many of them eventually come out of prison, and that’s how hepatitis C can be spread…on top of that, they come out and they become a burden to society, financially and in the health care system,” Jules Levin, executive director of the National AIDS Treatment Advocacy Program, says. Levin has been studying HIV and HCV since the late ’90s, after contracting both viruses himself; he has gone through antiviral treatment and no longer has HCV.
Not a single HCV-infected inmate in New Mexico had received antiviral treatment in 2003, when Arora came up with the idea for Project ECHO (Extension for Community Healthcare Outcomes), which is funded partly through the state DOH and partly through private grants. Inmates weren’t the only ones suffering; Arora’s hepatology practice at University of New Mexico Hospital had an eight- to nine-month waiting list. Many patients developed liver disease before they could get in to have the antiviral treatment and, by then, it was too late.
Realizing the challenge the disease presented for both prison clinics and rural health care providers without in-house hepatologists or gastroenterologists, Arora designed Project ECHO to link far-flung practitioners with UNMH specialists through teleconferencing. Once a week, participating providers around the state discuss patients with a panel that usually includes Arora, infectious disease and internal medicine specialist Dr. Karla Thornton, a psychiatrist, a pharmacist and a distance-learning coordinator. The patients’ identifying information is withheld to protect their privacy.
Project ECHO’s teleconferencing model has been so successful that it spun off ECHO programs to treat diabetes, HIV/AIDs, and other diseases and conditions that benefit from specialized care. The University of Washington took its cue from Project ECHO to start its own program by the same name, beginning with HCV treatment, before expanding to treat other diseases and health problems. In 2007, UNM’s Project ECHO won the international Robert Wood Johnson Foundation’s Askoha’s Changemakers award, one of numerous honors it has garnered. This summer, Arora is scheduled to give a keynote address at a hepatitis C symposium in Beijing, China.
Yet despite its award-winning program, New Mexico’s hepatitis C problem remains systemic—with many people unaware they have even been exposed to the disease.