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We’re focused on delivering treatments in areas of high unmet medical need and where current treatment options do not meet patient expectations.

Hepatitis C Elimination in the US

HCV experts are also working to eliminate the disease in the United States. We are highlighting what HCV micro-elimination looks like in the US to showcase the learnings, the challenges and the successes in the relentless pursuit to eliminate hepatitis C.*

* AbbVie is not directly affiliated with these efforts

Maryland

Telehealth in Appalachia*

In western Maryland, a university-based project has established a telehealth clinic here to improve care.

San Diego

Video: Dr. Christian Ramers

Dr. Christian Ramers discusses HCV elimination efforts in San Diego.

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Illinois

Video: Dr. Nancy Reau

Dr. Nancy Reau discusses HCV elimination efforts in Illinois.

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New York

Video: Dr. David Bernstein

Dr. David Bernstein discusses HCV elimination efforts in New York.

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Painful memories motivate mission

Every time João Semedo Tavares goes back inside the prison where he spent 10 years of his life, it’s déjà vu. He painfully relives his past – the haunting memories of life on the inside and every misstep on the outside.

But he willingly goes back inside prison walls, again and again, for a purpose that is bigger than himself. Tavares, is the founder of Johnson’s Academy, where he helps inmates learn how to re-enter society while they are still serving time. Now, Johnson’s Academy has a new mission. They have partnered with other organizations, including AbbVie, to launch a program called One Step More to help tackle a problem that plagues people who are incarcerated in prisons around the world – hepatitis C virus infection.

Through peer-to-peer counseling inside prisons, One Step More is educating people in prison on hepatitis C and helping connect them to the medical care available to them. The program helps people in prison prioritize their hepatitis C care and stay in treatment once they are no longer incarcerated.

“I was in prison for 10 years, and today I bring to prisons something I did not have in there,” Tavares says. “That's what motivates me in the day-to-day. Our presence is very important to people inside prisons and we really make a difference in their lives.”

One Step More

Hepatitis C infection is a common public health challenge in Portugal’s prisons, as it is in institutions around the world, for a variety of complex reasons. The practice of risky behaviors inside the prisons, such as sharing needles or having unprotected sex, is one reason that infection and re-infection rates are high.1,2 Portugal’s prison population includes an estimated 2,000 people infected with hepatitis C, a rate of infection that is nearly 20-times the general population.³

“It’s a small group, but it’s very important from an elimination perspective,” says André Bengala, the hepatology business unit manager for AbbVie Portugal, which partners with One Step More. “People in prison are deprived of their freedom, but they don’t have to be deprived of their health.”

To help solve this problem, all inmates are screened for hepatitis C when they enter a Portuguese prison, and the government provides funding for teams of health care professionals to travel to hospitals to diagnose and treat inmates. Still, up to 15 percent of those who test positive for the hepatitis C virus refuse treatment for various reasons, such as they don’t have any symptoms or they don’t trust the doctors and nurses, Bengala says.

“In the minds of many inmates, hepatitis C is not a problem that exists,” Tavares said.

Joana Dias, senior patient relations and strategic health initiatives manager, AbbVie Portugal, works with One Step More to develop training and educational lectures that help motivate people who are incarcerated to curb risky health behaviors so that after they have served their time, they are better prepared to thrive in life beyond the prison walls, and working toward a reduction in the spread of hepatitis C. “But some of the biggest hurdles are the prisons themselves,” Tavares said. Sometimes prisons will deny treatment or offer it only in exchange for good behavior, a practice that One Step More hopes to end.

“The biggest challenges for caring for people with hepatitis C who are incarcerated often relate to empathy,” says Guilherme Macedo, MD, a physician who has worked for decades to treat hepatitis C in Portugal’s prisons. “Micro-elimination projects like One Step More are a realistic way of overcoming this challenge so that we can truly achieve elimination.”

Helping others help themselves

The inspiration for One Step More hit Tavares after he was released from prison.

“I was motivated to change my life, but every time I tried to open a door, things did not go well,” Tavares says.

João Semedo Tavares, founder, Johnson’s Academy, during a peer-to-peer counseling session.

So he sought something that he didn’t have on the inside – help. He joined a community that guided him on how to reflect on his past, realize who he is today, and help others avoid his path. Through this process of self-reflection, Tavares realized that his experience could be used to help others. After founding Johnson’s Academy, Tavares teamed up with AbbVie to broaden his program’s scope to include the problem of hepatitis C.

At the core of One Step More is the idea that people in prisons are more likely to listen to their peers when it comes to frank discussions about personal matters, such as health. The foundation for these educational dicussions starts with the development of a peer-to-peer counseling network, drawn from leaders in formal and informal prison programs, for example heads of the various prison sports teams.

“This is what makes the project unique. The awareness and motivation to seek treatment is made by peers and not by outsiders,” Dias says.

“The doctors and nurses who go inside prisons to provide care can’t help patients if the patients are not ready to help themselves,” Tavares said. “This is why peer-to-peer education is so important to fight apathy or mistrust about hepatitis C care.” Without this education, he has seen little motivation on the part of those who are in prison to prioritize their health.

According to Tavares, One Step More also partnered with the prison division of Portugal’s Ministry of Justice and will launch a new pilot program for two institutions – working with both men and women – with the goal of expanding the project so that it can be replicated anywhere in the world.

Walking the red line

Once people are released from prison, One Step More keeps in touch to help them navigate a common hurdle of re-integrating into society. It’s this critical time known as the “red line period” where One Step More continues working with former inmates so they maintain treatment and medical care after leaving prison. During this seven-month probationary period, where many people fall out of care, One Step More helps them stay in treatment while avoiding the bureaucratic pitfalls of the red line period and the dangers that are in their community, such as the enticement of illicit drugs, that could put them back behind bars.

Today, Tavares is accompanying one such young man, who has hepatitis C, during his red line period. This young man was formerly reclusive and reluctant to treat his hepatitis C. Through One Step More, he received a hepatitis C consultation, and Tavares is shepherding him through the treatment process because he understands elimination is possible. He feels it’s his job to remove the barriers that have stopped so many before him.

“These people need me,” Tavares says. “So for me, this project is a dream come true.”

Recognizing a unique need

This story is the first in a series highlighting what hepatitis C micro-elimination looks like around the world. We’re zooming in on projects in different countries to showcase the learnings, the challenges and the successes in the relentless pursuit to eliminate hepatitis C.

When Christoph Hagenlocher first met Stefanie, a woman who used intravenous drugs, she was at rock bottom. As they ate lunch together in a drug treatment center in Stuttgart, Germany, back in 2014, Stefanie opened up about the challenges she was facing. She was addicted to heroin. Her daughter wouldn’t speak to her. She was homeless. Also, she had hepatitis C.

At the time, Hagenlocher, a health economist with AbbVie Germany, was travelling the country to speak with patients and care providers, searching for a solution to the public health challenge of treating  hepatitis C in people who inject drugs. As he listened to Stefanie, he heard a familiar story. She, like so many other patients, was mired in a web of other social, economic and health challenges, so it was hard for her to focus on treating the disease.

He realized only treating the infectious liver disease in patients like Stefanie wasn’t enough – but he was beginning to form an idea of what might be.

“It became clear to me that we’re going to have to do something special to help people who inject drugs at critical points in their lives so that they could one day prioritize their hepatitis C treatment,” Hagenlocher says.

Years later, with support from many different individuals and community organizations across Stuttgart, Stefanie found a path forward. She joined a newly formed, multi-layered support network, called Project PLUS, got help with her addiction, built social support, and found a place to live.

Then, now that she was ready, she got help to treat her hepatitis C.

Searching for a way to help people who inject drugs

An estimated 71 million people worldwide are infected with the hepatitis C virus.¹ Intravenous drug use is a major risk factor for infection,¹ but people who inject drugs often feel uncomfortable seeking medical care or are focused on other priorities, such as overcoming addiction or finding a job, Hagenlocher says.

To understand the challenges of treating hepatitis C in people who inject drugs, Hagenlocher shadowed workers at Caritas, a charity in Stuttgart that helps people overcome drug addictions. Caritas is a daily destination not only for help with addiction, but also to receive assistance with job applications, take cooking classes, play sports, and watch movies. These everyday activities help provide structure and routine, so that clients like Stefanie have time to think about other challenges they want to tackle, such as hepatitis C.

But Hagenlocher realized that once people were ready to address their infection, there were only a few counselors who could engage with patients in places like Caritas or in the streets, and just as few health care providers who were trained to treat hepatitis C in people with addiction disease.

Then came the second light-bulb moment: There was a need for a more engaged referral network between counselors and treaters. Hagenlocher got to work again.

Strengthening the care cascade

Project PLUS was implemented in additional cities as a referral network that would connect counselors with engaged health care providers who were willing and able to provide treatment for marginalized people with hepatitis C.

In Ludwigshafen, Project PLUS helped health care providers know where to send patients for treatment and what diagnostic procedures to perform, something providers previously had to figure out on their own.

One of those providers is Jörg Fränznik, a social worker who interacts with people outside of treatment centers. He credits Project Plus with creating a sustainable support system that has replaced previous, temporary projects. 

“Thanks to this initiative, I have a better relationship with other partners who provide support, because we have worked together on this common cause. This is a real improvement and relief,” he says.

Physician Petra Pflaum is part of the referral network through her community-based practice in Ludwigshafen. “Treating my HCV-infected patients was quite a challenge before Project PLUS, as there was no structure or network and I didn’t know enough about the therapy,” she says. “I can now treat my patients in a more effective and comprehensive way, which is a great feeling.”

Since 2018, the project has expanded to eight cities, with negotiations underway to expand to another eight, Hagenlocher said. Project PLUS began with the potential to help 1,000 patients. Now, he says, it has the potential to reach 28,000.

Becoming a role model for others

Stefanie was one of the first people to embark on the road to recovery with Project PLUS, and she is now free of hepatitis C. She has a job, a good relationship with her daughter, and her own apartment.

Recently, when Project PLUS held a big event to rally support for their work, she climbed the podium, told her story and thanked the network, hoping to inspire people who suffer from addiction to get care – and, just as importantly, to inspire others to help provide care.

“She is our role model,” Hagenlocher says. “It’s really quite emotional when you see patients that you met just a few years ago when they were struggling, and you see how powerful they are now.”

As good as it feels to help people like Stefanie, Hagenlocher is looking toward a future when projects and events like these are no longer needed.

“Our main objective is that the pillars we have developed will be incorporated into normal care delivery,” he says. “We want to bring these learnings into the standard of care so that Project PLUS is no longer necessary.”

Project PLUS is one example of a new concept, called micro-elimination, which has gained momentum for its potential to break down the societal barriers that make elimination difficult. AbbVie supports an estimated 300 micro-elimination projects globally in hopes of learning from what works and replicating that success elsewhere to help meet the 2030 elimination goal.

Media inquiries

Name: David Freundel
Email: david.freundel@abbvie.com
Cell: +1 (847) 937-4522

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