and 1965. This resulted in a fourfold increase in the number of patients screened. IHS facilities of the Southwest reported the largest gains in number of patients tested and the percentage of eligible patients that received testing. Currently, the incidence rate of acute hepatitis C in Native Americans is higher in comparison to any other racial/ethnic group (1.32 cases per 100,000). Additionally, Native Americans have the highest rate of hepatitis C related deaths (12.95% in 2015) in comparison to any other racial/ethnic group. Despite this prevalent need, IHS currently does not include any new direct acting anti-retroviral (DAA) hepatitis C medications on its National Core Formulary. New DAA drugs provide a cure to hepatitis C in most cases but are costly. Due to their lack in funding and quality of care, the IHS has not been able to effectively combat the Native American HCV issue, unlike the Veterans Affairs system, which was able to eradicate much of the disease through adequate resources from the federal government. Scholarships The IHS offers three types of scholarships to Native American students pursuing an education in healthcare: Preparatory Scholarship, Pre-Graduate Scholarship, and Health Professions Scholarship. The Health Professions Scholarship commits undergraduate and graduate students to a full-time service commitment after their professional training. These scholarships help to staff Indian health programs with Native American professionals. In addition, the IHS's Indians Into Medicine (INMED) program offers grants to universities to support Native American students in their medical education through mentorship, tutoring, financial aid, and more. It has also been used to support and encourage students before college to take pre-medical courses. Tribal self-determination Notable self-determination legislation In 1954, the Indian Health Transfer Act included language that recognizing tribal sovereignty and the Act additionally "afforded a degree of tribal self-determination in health policy decision-making." The Indian Self Determination and Education Assistance Act (ISDEAA) allows for tribes to request self-determination contracts with the Secretaries of Interior and Health and Human Services. The tribes take over IHS activities and services through an avenue called ‘638 contracts’ through which tribes receive the IHS funds that would have been used for IHS health services and instead manage and use this money for the administration of health services outside of the IHS. Self-determination successes and concerns The benefits and drawbacks of Tribal Self Determination have been widely debated. Many tribes have successfully implemented elements of health-related Self Determination. An example is