From a Long Battle With Hepatitis C to Care Advocate

Aaron Ferguson was in the military and had his sights on becoming a Navy Seal. He had made it through Hell Week, but did not graduate.

For the uninitiated, the Seals are the elite fighting force in the military and Hell Week is the culmination of the training seal candidates have to endure in order to graduate and become part of the team.

Ferguson was one of many candidates who sought another tryout with the seals. He trained again, and just as he was ready for another go at it, he was diagnosed with hepatitis C. Ferguson had donated plasma and found out he had the virus. This completely derailed his plans.

“Finding out I had hepatitis C changed the trajectory of my life,” Ferguson said.

Ferguson struggled with the virus for years and had his own challenges in getting into the continuum of care for HCV. “I was identified as having the virus myself back before many of these newer treatments were available. And the treatments that were available at the time were hard to access; they were emerging and very life-disrupting,” Ferguson said.

Whereas, hepatitis C changed his life and precluded him from serving in the seals, he has since found another significant role in his life: HCV care advocate. His long battle with HCV and subsequent cure gave him a “passion” to help others get into care.

Today, Ferguson is the Texas regional outreach manager with Community Medical Services, a national harm reduction-informed provider of medications for people with opioid use disorder. Ferguson also works to advocate for and implement methadone and buprenorphine treatments in jails, prisons, inpatient rehab settings, and communities in general. He is also a leadership team member and methadone liaison at the National Survivors Union, a national group of advocates for drug-user health.

On the ground level, Ferguson is getting people with opioid use disorder the help and support they need, and that includes getting treatment for those who have HCV. According to Ferguson, as much as 60% of people at the Texas clinics have tested positive for the virus. Many people may not realize they have the virus laying dormat and unaware of the long-term health consequences as well as the potential to pass the virus along to others who inject drugs.

His company shared some data from their Texas clinics as it relates to HCV testing, treatment, and outcomes (table).

HCV data courtesy of Community Medical Services

Texas and HCV Treatment: A New Approach
In many states, there are restrictions in place that preclude people with HCV to getting access to treatment through Medicaid. There has been an ongoing state-by-state movement that has helped removed prior authorization requirements for most patients. Since 2017, 33 states have either eliminated or reduced their fibrosis restrictions, 29 have loosened their sobriety restrictions, and 28 have scaled back their prescriber restrictions.

Biopharmaceutical company, AbbVie, has been working with stakeholders in individual states to help remove restrictions to curative HCV treatment. AbbVie’s HCV therapy, glecaprevir /pibrentasvir (Mavyret), is FDA approved and indicated to treat adults and children 3 years of age and older with chronic HCV. When the therapy was approved nearly four years ago, the FDA acknowledged that it could cure the virus.

“Direct-acting antiviral drugs reduce the amount of HCV in the body by preventing the virus from multiplying, and in most cases, they cure HCV infection,” said Jeffrey Murray, MD, MPH, deputy director of the Division of Antiviral Products in the FDA’s Center for Drug Evaluation and Research, said in their announcement.

In January, the Texas Health Human Services Commission (HHSC) removed all restrictions to Mavyret to reach Medicaid patients and their prescribers. HHSC selected Mavyret as the primary preferred therapy option for treating HCV in Medicaid patients, and it is the only direct-acting antiviral medication available to Texas Medicaid patients without prior authorization.

This initiative is looking to increase awareness, screening, diagnosis, and treatment for Texas Medicaid recipients. “We are excited for this partnership with AbbVie to reach more people with this disease in Medicaid so they can receive curative treatment,” Priscilla Parrilla, director of the Vendor Drug Program in Texas said in a statement when it was announced back in December.

In Texas, a remaining challenge for people who have opioid use disorder is getting access. “The main issue is that in the state of Texas, opioid use disorder is not considered disabling under Medicaid, and so roughly only 15% to 18% of our census down here is covered for their treatment services. So, the majority of the uninsured people get covered by a block grant or some other source of funding,” Ferguson stated.

Ferguson experienced gaps in access to care himself. He made too much money to qualify for public funding, but could not afford the HCV treatment. He and others have relied on outside organizations advocating on their behalf to the insurance providers to pay for their treatment or getting funding from other third-parties.

Still he acknowledges how this new state initiative should help to get more people into the continuum of care. “Medicaid requirements for receiving hepatitis C treatment have considerable improved over the last year and there have been some major legislative changes, so we are really hopeful to get more people cured.”

Contagion spoke to Ferguson about his efforts to get people linked to HCV care, as well as his experience navigating his own care.