Army Action Plan: Standard Operating Procedures for Hepatitis C Management

HEPATITIS C MANAGEMENT
SOP: 039 Page I of 4
DETAINEE HOSPITAL
SOP NO: 039 GUANTANAMO BAY, CUBA
Title: HEPATITIS C MANAGEMENT Page I 104 Effective Date: 11 Mar 03
SCOPE: Detention Hospital
1. SNCL:
(I) Hepatitis C Evaluation and Treatment Data Sheet Unhinso-ano1publicIF:20-Riggs19/cnicint SOPASOP Enclosures and Attachment:1%nel (11 Hepatitis C Data %wet foravaluation and
DIMI0e/VAN
(2) NM COMM= Statement on Hepatitis C Anhinmo-aonNoublic1E120-Riges1Warking SOPMSOP Enclosures and Attachment:NEM (21 Hep C N1H2002.ndf
IL BACKGROUND:
All detainees are screened for aerologic evidence of hepatitis C to identify infection among this population. The prevalence rate of hepatitis C has been approximated as 2% and depends on the prevalence of drug nee, blood transfietton, and unsafe medical • practices. Hepatitis C is a nador cause of cirrhosis, fiver Mum. and liver cancer. Treatment of hepatitis C may decrease the risk of progressive liver dysfimction and may
prolong life.
IlL POLICY:
Each detainee found to be hepatitis C positive by the ELISA screening test will be offered 'nether evaluation at the medical clinic. Each detainee will be given the appropriate information mending hepatitis C to•make a decision regarding a
• accepting/declining the evaluation and possible treatment of his/her hepatitis. Both the evaluation and treatment will be completely voluntary. The information collected on the
evaluation is found on the enclosed data form. The policybus stated in this SOP has been coordinated through consultation with the Gastroenterology Division, NavalMedical Center San Diego.
IV. PROCEDURES:
o The following sections deal with the description and elaboration of the Hepatitis
C Evaluation and Treatment Data Sheet. Screening for hepatitis C occurs upon arrival of the detainee at Naval Base Guantanamo Bay. NBGTMO.

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HEPATITIS C MANAGEMENT
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o Those found to be positive for hepatitis C by the screening ELISA test represent a
possible case of active hepatitis C. a•
a The detainee with active hepatitis C is infectious to other detainees and .1 TF personnel via contact with the detainee's blood. Saliva, vomitus, feces, and perspiration we not contagious unless these seen:dons contain blood. Since there is no anent preventive therapy for those exposed to potentially contagious secretions of a hepatitis C patient, information regarding the hepatitis C ststus of each detainee will be used to follow those exposed to monitor for the
development of the Infection.
o Hepatitis C infection may result in resolution elite infection by the immune system in 15-40% of cases or may lead to persistent active hepatitis in 6045%, which may lad to ptogressive liver dysfuno6on. Therefore, each detainee with a positive hepatitis C ELISA test will be offered further evaluation of this medical
condition.
o The appropriate work-up will be initiated among those detainees who desire evaluation of their hepatitis C including assuring that serologic: for hepatitis A, B, C are obtained. Each detainee will be asked about potential symptoms related tohepatitis C and undergo a physical examination. Liver Bawd= testa, PT/PRT/INR, hepatitis C RNA viral load, and genotype will also be obtained as
shown oust he data collection sheet (see Enclosure 1).
o Detainees with a positive hepatitis C ELISA and positive hepatitis C viral load will be diagnosed with active hepatitis C. Those with a negative hepatitis C viral load will be reevaluated at 4-6 months with a repeat viral load measurement; those negative on both viral load tests will be classified as a false-positive ELISAtest or someone who has resolved hepatitis C. This later group will not be tbrtherevaluated and do not require therapy.

o Those who we potential candidates for therapy will be referred to Behaviotal

Health for an initial evaluation so identify early any psychiatric problems whichmay preclude therapy with interferon.
o A liver biopsy will be offered to those with active hepatitis C. If the detainee
refuses this procedure, therapy will still be offered inappropriate cases.

a Based on the resuhs of the aforementioned tests, each case will be discussed witha boartkerdfled infectious diseases and/or pstroenterologist in regards the
initiation of danapy.
o If the detainee meets indications for treatment. the patient will be offered
treatment with peg-interferon and ribavirin. Therapy for hepatitis C will be

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HEPATITIS C MANAGEMENTa
SOP: 039 Page 3 .f 4
administered for6-12 months depending on the genotype and response to therapy; this anurnes that the patient complies with and tolerates the therapy.
a The patient will be closely monitored for potential side effects of the therapy at routine clinic visits. Psychiatry will also follow the detainee while he/she istreated with peg-interferon.
a Since the standard of care for the evaluation and therapy of hepatitis C evolving. the diagnostic testing and drugs may change over time. Detainees should coati= to obtain the standard-of-care of hepatitis C management.
a Detainees refining therapy will be followed with mains medical clinic visits including liver !Unction test approximately every 6 months or as clinicallyincrscated.
a All patients with hepatitis C. will also be offered vaccination against hepatitis A which is a 2-dose vaccine given 0 and 6-12 maths and hepatitis 13 which is a3-dose vaccine at 0,1 and 6 months for all then not already imimme.
o Detainees with evidence of hepatitis C cirthosis nil be offered screening forhepatoma with an alpha-fetoprotein (AFP) and/or right upper quadrant ultrasound
every 6-12 months.
HEPATITIS C MANAGEMENT
SOP: 939 Page 4 of 4
STANDARD OPERATING PROCEDURES Detention Hospital Guantanamo Bay, Cuba
REVIEWED AND APPROVED BY: ,
Officer In Charge Date
IMPLEMENTED BY:
Director for Administration Date
Senior Enlisted Advirx . Date
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By: Data
By Date:
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SOP REVISION LOG:
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ENTIRE SOP SUPERSEDED BY:
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