Nurse Practitioner/Physician Assistant Education and the Management of HCV

Article excerpt

Abstract: In this article, the authors discuss the consequences of the 911 attack on the United States and the concomitant increase in the noted prevalence of Hepatitis C Virus due to the presence of the virus in the blood donors. The authors discuss the background and consequences of infection with the virus, epidemiology, impetus for curricula development, curricular outcomes, curricula modules, and HCV case management for nurse practitioners (NPs) and physician assistants (PAs).

Key Words: Nurse Practitioner Education, Physician Assistant Education, HCV Infection, Case Management of HCV.

The horrendous act of 911 brought Hepatitis C Virus (HCV) awareness to the forefront of public health concerns. Many of the courageous people on that day wanted to assist those less fortunate. These were the people who had terrible burns, broken bones, and severely punctured wounds. These were people who needed blood transfusions to possibly sustain life. Volunteers arrived at the hospitals in large numbers. A noble act for certain. However, a problem existed that was not anticipated. To the surprise of many health care workers, many of the donors unknowingly were infected with HCV. HCV very quickly and quietly has become a serious public health concern and problem.

BACKGROUND

HCV is one of the leading known causes of liver disease in the United States. Thirty-five thousand new cases occur annually; and the number of adults infected with HCV is projected to increase by fourfold. HCV is found in at least 1.8 percent of the population, and is the most common chronic bloodborne disease in the United States.

The Virus

HCV is a virus of the Flaviviridae family. There are six HCV genotypes and more than 50 subtypes. These genotypes differ by as much as 31 - 34 percent based on their nucleotide sequences; whereas, subtypes differ by 23 to 23 percent based on a full-length genomic sequence comparisons. The lack of a vigorous T-lymphocyte response and the high propensity of the virus to mutate, appears to promote a high rate of chronic infection. The extensive heterogeneity of HCV has important diagnostic and clinical implications. Genotype 1 accounts for 70 - 75 percent of all HCV infections in the United States, and is associated with a lower response rate to treatment (National Institute of Health [NIH], 2002).

Epidemiology

It is estimated according to the National Health and Nutrition Examination Survey (NHANES, 1994) that over 3.9 million Americans were infected with HCV. It has also been estimated that of this group, 2.7 million are chronically infected. This figure does not include members of the population who are incarcerated, homeless, or institutionalized. Because most members of the population with chronic HCV infection have yet to be diagnosed with chronic HCV, it has been projected (1990 - 2015) that in the next decade those infected are likely to seek medical attention. Currently, persons aged 40 -50 years have the highest prevalence of HCV infection, and in this group, the prevalence is highest (6.1 percent) in African Americans (NIH, 2002). Transmission primarily occurs through exposure to infected blood. This exposure includes injections from drug use, unsafe medical practices, occupational exposure to infected blood, and birth to an infected mother, sex with an infected person, high-risk sexual practices and intranasal cocaine use. Any persons having blood exposure related to blood transfusions or organ transplants prior to 1992 would benefit from HCV testing. The introduction of serosensitive tests virtually eliminated transmission of HCV from blood products and organ transplants (NIH, 2002). HCV seroprevalence rates (from 15 to 20 percent) have occurred in specific subpopulations, such as the homeless, incarcerated persons, injection drug users, and persons who were treated with hemophilia who were treated with clotting factors before 1992. The highest seroprevalence rates (70 percent to more than 90 percent) have been reported in the last two of these groups. …