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SGM No. 19-02
May 16, 2019
TO: Area Directors
FROM: Principal Deputy Director, Indian Health Service
SUBJECT: Hepatitis C: Universal Screening and Treatment

The purpose of this Special General Memorandum (SGM) is to support and coordinate efforts in the Indian Health Service (IHS) to implement and exceed the recommendations of the Centers for Disease Control and Prevention (CDC) by expanding universal screening for the Hepatitis C Virus (HCV) to all patients over the age of 18 years at least once in their lifetime, followed by guideline-based treatment, as appropriate. This universal screening guidance supplements and does not replace more frequent risk-based testing. Screening for HCV is part of a nationwide effort to prevent and control HCV infection and HCV-related chronic disease. Exit Disclaimer: You Are Leaving  .

Among American Indian and Alaska Native people, HCV related mortality remains more than double the national rate. In a recent IHS survey, almost 50 percent of the individuals diagnosed with HCV were born after 1965. Untreated HCV can lead to a myriad of extrahepatic manifestations and cirrhosis with complications such as portal hypertension, end stage liver disease, and hepatocellular carcinoma (HCC). Early diagnosis and treatment of HCV infection prevents the development of extrahepatic manifestations and progressive liver disease, including cirrhosis.

The treatments for HCV are highly effective and greatly reduce all HCV and HCC related mortality. Treatment for HCV can be highly successful at the primary care level with appropriate planning and support. Universal screening has been determined to be cost-effective and is recommended by the IHS National HCV Workgroup. Therefore, all IHS direct care facilities are expected to establish and implement universal HCV screening and treatment protocols in a strategic manner.

I am relying on the full support of Area Directors, Area Chief Medical Officers and Clinical Directors to promote the implementation of, at all IHS direct care facilities, universal HCV screening and treatment of all those with chronic HCV infection.

Effective Date

This SGM becomes effective on the date signed.

/Michael D. Weahkee/
RADM Michael D. Weahkee, MBA, MHSA
Assistant Surgeon General, U.S. Public Health Service
Principal Deputy Director
Indian Health Service