Fields in which health care interventions are integrated with public health strategies appear to have the greatest potential for completing the National Institutes of Health (NIH) bench to bedside to community progression. We suggest that public health approaches and partnerships may facilitate the accomplishment of the objectives of the NIDDK 10-year plan targeting the prevention and care of viral and fatty liver conditions and their complications for all Americans. Despite the swift progression in our knowledge of hepatitis C from the identification of the virus in 198940 to the development of evidence-based guidelines for its management and treatment in 1997,41 the rates of

screening, access to treatment, and successful outcomes of treatment are unacceptably low.42, Selleckchem ABT-263 43 Indeed, the three primary recommendations of the recent Institute of Medicine report on the prevention and control of HCV are (1) to improve disease surveillance, (2) to improve patient and community education, and (3) to integrate and enhance Selleckchem KU-60019 viral hepatitis services.44

Furthermore, the AASLD and NIH recognize that it is especially difficult to initiate and manage antiviral treatment in several populations that are disproportionately affected by hepatitis C, including current or recent illicit drug users and patients without stable housing.45, 46 We have yet to establish health care models in the United States that effectively identify, treat, and manage the diverse individuals infected with HCV. With the advent of promising new HCV therapies, it is critical to improve the current health

care delivery systems for hepatitis C. We believe that improved viral hepatitis surveillance, management, and treatment outcomes will require the use of public health strategies and the adoption of disruptive selleck kinase inhibitor innovations, such as integrated care models or HCV treatment delivery within methadone or homeless clinics.47-49 It is incumbent upon hepatology investigators with health service research and implementation science expertise to develop effective strategies and models of viral hepatitis surveillance, management, and treatment. In contrast to HCV, fatty liver disorders are biologically more heterogeneous with a more complex pathophysiology. This may explain the longer interval between the characterization of the syndrome in 198050 and the only recent demonstration of efficacious therapies.51 Indeed, the development of specific treatments for these disorders is challenged by the fact that fatty liver conditions are typically only one manifestation of an underlying metabolic or toxic pathology. Despite concerted efforts to understand the pathophysiology of nonalcoholic fatty liver disorders, identify targets for therapy, and perform rigorous efficacy trials,4, 52, 53 the number of individuals with fatty liver disorders and their complications continues to swell.