Threatens HIV, Severe Hepatitis C Threat in Rural Missouri | Political solution

Jan Morrow, director of the Ripley County Health Department, found an increase in cases of hepatitis C. She said that she could not be sure if it was due to the county methamphetamine problem or to the national opioid epidemic but that had to be remedied.

The problem is a small public health staff – only eight full-time employees – "

Now, the risk of another outbreak is looming in the rural counties of Missouri that, like Austin, have high poverty rates and limited access to health care. Despite this risk, the decline in public health funding in Missouri has forced counties such as Ripley to do more with less.

At the Madison County Public Health Center in Fredericktown, south of St. Louis, a quarter of the county's population goes every month for health care. Space is limited and some administrators share an office.

This outdated facility is only one sign of a general lack of funding for public health in the state. The Missouri Department of Health and Seniors' Services, which oversees statewide public health, has requested an increase of $ 86 million by 2018. Then-Gov. Instead, Eric Greitens recommended that his budget be reduced by more than $ 54 million.

The public health department receives millions of dollars in opioid-related grants each year, but most of it goes to HIV treatment. Sara O & Connor, DHSS spokeswoman, said in an email that the Bureau of HIV, STDs and Hepatitis "currently has no federal or national funding specifically dedicated to the consequences of the current opioid crisis on HIV and / or viral hepatitis. "

Craig Highfill, director of field office prevention services, and Nicole Massey, chief of the office, said that AIDS was receiving the majority of funds and that it was not easy to reallocate funds to something else.

Randall Williams, director of DHSS, said funding was not the problem.

"We spend close to one-fifth of our gross domestic product in health care in this country, which is much more than most other industrialized countries, "said Williams. "So the question then becomes, can we spend this money in a better way to get better results? And I think we can."

Morrow said the photo was different when it faced " in the trenches "at county level. Public health has always been a low priority in the budget, she said.

Most of the CDL's at-risk counties are rural areas in southeastern Missouri, some of which are fortunate to have a supermarket, not to mention specialized health. Many people depend on Medicaid for their health coverage.

According to a state report on vulnerability to HIV and hepatitis C in Missouri, there has been no significant increase in these diseases in counties identified by the CDC. In the past five years, there have been 27 new HIV cases and nine confirmed cases of acute hepatitis C in 13 counties. However, the report warns that a reduced sample and limitations in data collection make it difficult to identify trends.

Testing and treatment for HIV and hepatitis C vary by region, but patients often need to be referred to more distant cities. 19659003] Teresa Francis, a registered nurse from Madison County, said she was sending HIV-positive patients to the Cape Girardeau County Public Health Center, an hour and a half away.

Amber Elliott, Deputy Director of St. The Francois County Health Center, said that many people in his county were not insured, so they are referred to the University of St. Louis and the University of Washington – a 75-minute ride

There are few resources to improve access to health care. Medicaid offers a certain refund for transportation costs. A public bus travels every month from Butler County to Cape Girardeau, the home of the nearest HIV care clinic – a day when the clinic is not open

The Medicine published a study suggesting that other largely rural areas at risk of an epidemic should focus on prevention, such as increasing HIV testing, access to treatment and l & # 39; education. However, in the two years since the publication of the CDC study, Missouri has taken little action to guard against the risk of an HIV or hepatitis C epidemic.

Bureau officials said they had focused their efforts on health centers to increase testing. With a declining budget, it has been difficult to focus on new prevention initiatives.

After the report was released, Kerri Tesreau, Acting Director of the Community and Public Health Division of DHSS, told reporters that more funding would be available at the local level to combat a potential epidemic.

Rob Simon, chief nurse at the Cedar County Health Center, said the first responders in Cedar County are still busy with other health needs. Naloxone, a drug that can reverse the effects of an opioid overdose, has not been administered.

In addition, health problems such as smoking, heart disease and obesity are competing for money and attention.

Madison County voters approved a 15-cent increase in property tax for the Public Health Center's budget.

"It was not much," said Francis. "We are just at the point where we have nothing else to do but reach the community."

Several of the 13 at-risk counties are partnering with HepC Alliance, a non-profit organization based in Colombia that provides hepatitis C testing and information to public health centers.

"We must always look for ways to be more creative, to team up with others, to make sure we take advantage of everything we have," said Williams

. Mrs. Morrow said that she would like to work more proactively, but that resources are hard to find until there is a real epidemic and the problem is visible

" If prevention works, no one notices it. " This story was produced by students in an investigative reporting class at the University of Missouri's School of Journalism, taught by Sara Shipley Hiles, a former journalist from Post- Dispatch