Report of Viral Hepatitis Related Activities

Transcription

1 Report of Viral Hepatitis Related Activities

2 Table of Contents Introduction 1 Background and Purpose New York State Viral Hepatitis Strategic Plan ( ) 1. Prevention 1 Hepatitis C Rapid Testing Integrated HIV, STD and Hepatitis C Testing Survey Hepatitis Outbreak Investigations in Health Care Facilities Perinatal Hepatitis B Prevention Program Adult Hepatitis Vaccination Program (AHVP) Hepatitis B Hospital Birth Dose Initiative 2. Education 5 Hepatitis C Video and Companion Booklet HIV and Hepatitis C Co infection Clinical Guidelines Training for Non Physician Health and Human Service Providers National Viral Hepatitis Technical Assistance Center National Viral Hepatitis Awareness Month HIV Clinical Education Initiative One and Only Campaign Perinatal Hepatitis B Manual Discharge Packets for Prison Inmates Being Released 3. Surveillance and Research 8 Burden of Hepatitis C Virus in New York State Continued Management of the Chronic Hepatitis Disease Registry Enhanced Acute Hepatitis Surveillance Project Retrospective Review of Acute Hepatitis B among Adults with and without Diabetes Hepatitis C Virus Clinical Test Applications HIV Registry and Chronic Hepatitis Registry Match Prevalence and Transmission of Hepatitis C among HIV infected Childbearing Women Delivering in NYS Hepatitis C and HIV/Hepatitis C Co infection in NYS DOCCS National HIV Behavioral Surveillance (NHBS) 4. Medical Care and Treatment 12 Hepatitis C Continuity Program Expanding the Capacity to Provide Hepatitis C Care and Treatment Hepatitis C Assistance Program (HepCAP)

3 5. Policy and Planning 13 NYS Viral Hepatitis Strategic Plan ( ) Hepatitis Integration Work Group Hepatitis C Advisory Council Viral Hepatitis Community Work Group Collaboration with Community Health Center Association of New York State (CHCANYS) Conclusion 15 Table 1. NYSDOH Viral Hepatitis Related Activities: 2011 Timeline 16

4 Introduction Background and Purpose The purpose of this report is to summarize highlights of viral hepatitis related activities of the New York State Department of Health (NYSDOH) during Hepatitis related activities are pursued within numerous distinct program units across several NYSDOH organizational subdivisions the Center for Community Health (CCH), AIDS Institute and Wadsworth Center. While coordination and collaboration among these entities to advance hepatitis issues is longstanding, the extent of cooperative efforts continues to expand. New York State Viral Hepatitis Strategic Plan ( ) The mission of the NYS Viral Hepatitis Strategic Plan ( ) is to outline a coordinated, comprehensive and systematic approach that will decrease the incidence and reduce the morbidity and mortality of viral hepatitis. The vision is to eliminate new hepatitis A, B and C infections and improve the quality of life for individuals living with chronic hepatitis B and C. The NYS Viral Hepatitis Strategic Plan ( ) includes separate frameworks for hepatitis A, B and C. Each framework is inclusive of a wide range of goals and strategies necessary for a comprehensive approach. The success of the Strategic Plan involves a coordinated, collaborative and sustained approach for viral hepatitis prevention; education; surveillance and research; medical care and treatment; and, policy and planning. The NYSDOH engages and facilitates the involvement of others in carrying out the necessary activities to achieve the Viral Hepatitis Strategic Plan s goals and strategies. By aligning activities with the NYS Viral Hepatitis Strategic Plan, the NYSDOH and others maximize opportunities to eliminate new hepatitis A, B and C infections and improve the quality of life for individuals living with chronic hepatitis B and C. This report provides highlights of how the NYSDOH, in its leadership role, is pursuing the goals and strategies of the NYS Viral Hepatitis Strategic Plan ( ) through program and policy development. Each section of the report mirrors the focus areas of the Strategic Plan (prevention; education; surveillance and research; medical care and treatment; and, policy and planning) and summarizes the goal for each focus area. 1. Prevention To prevent the acquisition and transmission of the hepatitis A, B and C viruses (including the perinatal period through adulthood for hepatitis B), the NYSDOH accomplished the following during 2011: Hepatitis C Rapid Testing During 2011, the AIDS Institute prepared for the launch of the Hepatitis C Rapid Test Demonstration Project. A total of 12 sites across NYS were selected to participate in the project and will receive free hepatitis C rapid test kits from OraSure Technologies, Inc. Page 1

5 Programs participating include community health centers, syringe exchange programs, drug treatment programs, AIDS service organizations and hospital based clinics. Sites are geographically located in areas where the AIDS Institute s funded Hepatitis C Care and Treatment Programs are located. Trainings for the 12 programs were held in May and June The trainings included information on the purpose of the demonstration project, program requirements (i.e., CLIA waiver, data collection and referral linkages) and an overview of hepatitis C counseling messages. Program staff were also trained on how to use the rapid test, interpret test results and perform quality controls. The project duration is six months and is expected to begin in early Integrated HIV, STD and Hepatitis C Testing Survey In 2010, the AIDS Institute s Office of Program Evaluation and Research developed a survey to explore ways in which NYS HIV counseling and testing providers (including, but not limited to, AIDS Institute funded) provide HIV, STD and hepatitis C testing/screening for their clients/patients. The survey was designed to obtain information regarding providers integrated screening and referral practices (including the number of persons tested for HIV, STDs and hepatitis C in 2010), the nature of partnerships/collaborations for STD and hepatitis C screenings and technical assistance/training needs that would enhance agencies capacity to perform or build partnerships for STD and hepatitis C screenings. The survey is part of a larger effort to better understand the ways in which HIV, STD and hepatitis C testing are promoted and provided to clients/patients in NYS and the ways in which the NYSDOH can assist agencies and providers to accomplish this goal. The survey was implemented in 2011 and data collection was completed. Overall, 40 agencies participated and, of these, 22 routinely conduct hepatitis C screening (direct service or referral) and 23 reported being interested in learning about hepatitis C rapid testing. Data are currently being analyzed for presentation in Hepatitis Outbreak Investigations in Health Care Facilities The Healthcare Epidemiology and Infection Control (HEIC) Program, located within the Bureau of Healthcare Associated Infections, oversees health care associated outbreak reporting and investigates reports of health care associated infections, including viral hepatitis. In 2011, the HEIC Program investigated six hepatitis B and 16 hepatitis C reports in patients with health care exposures. Observations made during some of these investigations led to the NYSDOH releasing two informational messages to health care facilities and providers in NYS to help prevent bloodborne pathogen transmission. The first, released in March 2011, provided a reminder to practice strict infection control during diabetes care. The message stressed the importance of single patient use lancing devices and cleaning and disinfecting reusable glucometers if they cannot be dedicated to a single patient. The second informational message, released in September 2011, recommended dedicating personal care items (e.g., nail clippers) to a single patient whenever possible. HEIC Program staff also participated in a multidisciplinary team to revise the NYSDOH Policy Statement and Guidelines to Prevent Transmission of Bloodborne Pathogens from Infected Health Care Personnel through Medical/Dental Procedures. The updated policy statement and guidelines emphasize voluntary testing of health care personnel (HCP) and case by case Page 2

6 evaluation of bloodborne pathogen infected HCP who perform invasive procedures to determine if they pose a significant risk to patients. NYSDOH asserts that bloodborne pathogen infection alone is not sufficient justification to limit the professional duties of HCP unless specific factors compromise HCP s ability to meet infection prevention and control standards or to provide quality patient care. Perinatal Hepatitis B Prevention Program The NYSDOH Immunization Program s Perinatal Hepatitis B Prevention Program identifies and tracks pregnant women who are hepatitis B surface antigen (HBsAg) positive to help ensure that the newborn infants of these women receive appropriate immunoprophylaxis to prevent the transmission of the hepatitis B virus from mother to baby. Infants are followed until the hepatitis B series and the post vaccination serology testing is completed. Household, sexual and needle sharing contacts of the women are also screened and vaccinated, if susceptible. The program, which is mandated by NYS Public Health Law 2500 e, requires close case management, tracking and follow up of all identified cases by the local health departments and cooperative informationsharing between prenatal care providers, hospitals, pediatricians, local health departments and the NYSDOH. An important quality assurance component of this program includes regularly scheduled visits to birthing hospitals by state and local health department staff to conduct maternal and infant medical record reviews and update hospital staff on current program issues and recommendations. In January 2009, the site visit certificate of excellence was amended to include not only 100% compliance with NYS Public Health Law 2500 e, but hospitals must also demonstrate a hepatitis B birth dose rate of 90% or greater. In 2011, 15 birthing hospitals surveyed achieved this goal. Adult Hepatitis Vaccination Program (AHVP) The Bureau of Immunization provides hepatitis A, hepatitis B and combination hepatitis A and B vaccine to local health departments for highrisk adults seeking services in all high risk settings including STD, HIV and adult immunization clinics. Since the program began in 1995, more than 258,000 doses of vaccine have been administered through this program. In 2010, federal 317 funding for the AHVP was cut, but the Bureau of Immunization continued to provide adult hepatitis vaccines to participating facilities in 2011 through NYS funding. STD Clinics and STD/HIV Treatment Centers A total of 79 STD clinics and three STD/HIV Treatment Centers are actively enrolled in the AHVP and offer hepatitis vaccines to their clients. In 2011, more than 8,900 doses were administered from STD clinics. County Jail Hepatitis Vaccination Project A total of 45 county jails are actively enrolled in the AHVP and offer hepatitis vaccination services to inmates. In 2011, more than 4,700 doses of vaccine were administered to inmates. Page 3

7 Indian Health Centers One Indian Health Center is enrolled in the AHVP. Efforts continue to conduct outreach and collaborate with these populations. In 2011, 32 doses of vaccine were administered at the Indian Health Center. OASAS Affiliated Methadone Treatment Centers and Addiction Treatment Centers In 2011, eight addiction treatment centers and 14 methadone facilities enrolled in the AHVP and more than 2,200 doses of vaccine were administered at these sites. Community Health Centers Presently, there are seven community health centers from the Metropolitan Region enrolled. In 2011, more than 5,100 doses of vaccine were administered to clients of the community health centers. Federally Qualified Health Centers In April 2010, the Bureau of Immunization reached out to Federally Qualified Health Centers (FQHCs) to enroll in the AHVP. Letters of invitation were sent to facilities and an announcement was placed in the Community Health Care Association of NYS (CHCANYS) newsletter. Presently, there are 11 FQHCs enrolled in the AHVP. In 2011, more than 1,300 doses of vaccine were administered to clients at FQHCs. Rural Health Centers In November 2011, the Bureau of Immunization reached out to Rural Health Centers to enroll in the AHVP. Presently, there are five Rural Health Centers enrolled in the AHVP. In 2011, one dose of vaccine was administered to a client at a Rural Health Center. Migrant and Seasonal Farmworker Immunization Project The Migrant and Seasonal Farmworker (MSFW) Immunization Project provides free vaccines, including hepatitis A and B, to MSFWs older than 19 years of age and their adult family members. Vaccines are provided by 33 enrolled migrant health care providers, including three FQHCs operating in nine locations and providing services in more than 30 counties. A total of 18 local health departments provide immunization services to MSFWs. Immunization services are provided to MSFWs at a variety of health care settings or in a camp. In 2011, more than 5,600 MSFWs received more than 6,700 vaccines, including more than 1,600 doses of hepatitis A, B and combined hepatitis A and B. Hepatitis B Hospital Birth Dose Initiative The Hepatitis B Hospital Birth Dose Initiative, started in October 2003, provides NYS funded hepatitis B vaccine, free of charge, to any NYS birthing hospital that implements standing orders for all newborns to receive hepatitis B vaccine at birth. Through this program, the NYSDOH hopes to eliminate additional hospital costs for vaccine purchase and improve hospital compliance with recommended standards of practice. With the enrollment of all birthing hospitals in NYS in the birth dose program, the Bureau of Immunization has increased its focus on improving rates. In 2010, a survey was completed of best practices from birthing hospitals with birth dose rates exceeding 90%. In 2011, the same survey was conducted with hospitals having birth dose rates below the NYS average of 73.4%. Results from both studies indicated that best practices for increased rates include: parental education regarding the benefits of the birth dose should be provided early in the prenatal/childbirth classes; the vaccine information statement (VIS) Page 4

8 should be presented and consent to vaccinate should be obtained from the mother prior to entering the delivery room; and, hospital staff (especially pediatricians) benefit from training and education on perinatal hepatitis B and the universal birth dose. Results of the initial survey were included in the 2011 Perinatal Hepatitis B Manual and were presented at the 2011 National Immunization Conference in Washington, DC. 2. Education To build knowledge and awareness of hepatitis A, B and C disease, prevention, risk, treatment and medical management, as well as vaccination for hepatitis A and B, the NYSDOH accomplished the following during 2011: Hepatitis C Video and Companion Booklet An internet based, 30 second video was developed to target young people at risk for hepatitis C. Content for the video was informed from focus groups with young people, including members of the NYC Youth Network and Young Adult Consumer Advisory Committee (YACAC), as well as consumers from Foundation for Research on Sexually Transmitted Diseases (FROSTD). A companion booklet that provides prevention and education information on tattooing, body piercing and injection drug use was also developed. Upon completion of production, which is targeted for early 2012, the video will be posted to the MTV web site as a teaser video to be played as an introduction to music videos. The video will also be posted on YouTube and shared with young people for posting on social media sites (e.g., Facebook). HIV and Hepatitis C Co infection Clinical Guidelines The NYS HIV Clinical Guideline, HIV and Hepatitis C Co infection: Guideline and Commentary, was noted as the third most read article in 2011 by HIV/AIDS physicians on the Medscape HIV/AIDS web site. The guideline, completed in May 2010, was first featured on Medscape on January 5, It currently remains the most ed article from this web site. The Medical Care Criteria Committee, composed of expert physicians from NYS, will be revising the guideline in 2012 in light of new treatment options. The Hepatitis B Virus guideline was in the final stage of revision in Training for Non Physician Health and Human Service Providers During 2011, regional training centers supported through the AIDS Institute s HIV Education and Training Programs offered four distinct curricula on viral hepatitis for non physician health and human service providers: It s Time: Integrate Viral Hepatitis into Your Work was a two day training delivered four times to 59 providers; HIV and Hepatitis C Co infection for Case Managers was a one day advanced training delivered four times to 50 case management staff; HIV/Hepatitis C Co infection and Use of Motivational Interviewing to Reduce Alcohol Use was a one day training delivered three times to 74 providers; and, HIV and Hepatitis C Co infection was a half day training delivered 10 times to 181 providers. In addition, the AIDS Institute s Education and Training Programs contracted the development of two, one day trainings to support the initiation of hepatitis C support groups at the AIDS Institute s funded Hepatitis C Care and Treatment Programs sites: Developing a Hepatitis C Peer Support Program was delivered twice to 19 program Page 5

9 management staff and What Peers Need to Know about Hepatitis C was delivered twice to 26 peers recruited from agencies funded by the AIDS Institute. National Viral Hepatitis Technical Assistance Center The AIDS Institute s Office of the Medical Director, in collaboration with the Office of Program Evaluation and Research, is in its fourth year of a five year Cooperative Agreement with the Centers for Disease Control and Prevention (CDC) to serve as the Technical Assistance (TA) Center to support the work of CDC funded Adult Viral Hepatitis Prevention Coordinators (AVHPCs) across the country. During 2011, the National Viral Hepatitis TA Center conducted monthly TA conference calls for all AVHPCs and provided more than 340 distinct TA interventions to 47 state or local health department s hepatitis prevention programs. Highlights from 2011 include facilitating two, two day Viral Hepatitis Institutes for newly hired AVHPCs, conducting on site strategic planning sessions in two jurisdictions and building capacity of other hepatitis training in numerous jurisdictions. The TA Center facilitated four different work groups on critical topics including rapid hepatitis C testing and developing tools for program implementation; promoting integration of hepatitis in HIV community planning groups; promoting collaboration with Federally Qualified Health Centers (FQHCs); and, networking and information sharing among newly hired AVHPCs. The TA Center coordinated a series of focus groups with AVHPCs to provide the CDC with input on the development of a future Funding Opportunity Announcement (FOA) by the Division of Viral Hepatitis and a focus group to gather input regarding the development of the formative research guide for the CDC s National Education Campaign on Hepatitis B and C. The TA Center continued to collaborate with the Mid Atlantic Federal Training Center Collaborative which included the regional AIDS Education and Training Center (AETC), Addiction Technology Transfer Center (ATTC), Tuberculosis (TB) Training Center, STD Training Center and Family Planning Title X Training Center to offer a series of one day training updates on HIV, STDs, viral hepatitis and TB, and to plan a series of webinar case studies. The TA Center assisted with curriculum planning, inclusion of hepatitis content and development of an evaluation tool to assess the value of offering cross disciplinary updates. National Viral Hepatitis Awareness Month In recognition of National Viral Hepatitis Awareness Month in May 2011, staff from the AIDS Institute and Bureau of Immunization collaborated to coordinate various activities. Activities included a proclamation signed by the NYS Governor recognizing May 2011 as Viral Hepatitis Awareness Month in NYS; two banners announcing National Viral Hepatitis Awareness Month displayed at the Empire State Plaza, Madison Avenue overpass in Albany; a NYSDOH press release; hepatitis related posts to the Facebook social media web site; and, webinars regarding perinatal hepatitis B. HIV Clinical Education Initiative The HIV Clinical Education Initiative (CEI), with experienced faculty from academic medical centers/designated AIDS Centers, provided comprehensive trainings on hepatitis A, B and C. Most of these trainings were CE approved through the State University of New York (SUNY) Albany, School of Public Health and/or other accredited sites. Page 6

10 The purpose of the trainings was to educate clinicians in the diagnosis and management of HIV/hepatitis co infections. One and Only Campaign Dissemination of the One Needle, One Syringe, Only One Time message, with a focus on NYS health care providers, was the main mission in the second grant year for the NYS One and Only Campaign. The threat that hepatitis B and C could be spread to patients by unsafe injections led to the formation of this national and state injection safety educational campaign. NYSDOH s campaign is funded by the Centers for Disease Control and Prevention (CDC) and is directed by the Safe Injection Practices Coalition (SIPC), of which CDC is a member. Highlights of the One and Only Campaign during 2011 include the following: Targeted mailings of educational materials to 5,000 NYS providers with a concentration on certain specialties (e.g., anesthesiologists, oncologists, plastic surgeons, podiatrists, nurse practitioners). A national/international satellite broadcast on May 19, 2011 regarding injection safety, hepatitis and the campaign by the State University of New York (SUNY) Albany, School of Public Health s Public Health Live program. The program was viewed by more than 5,800 participants (including 2,000 from a South Sudan clinic) and was archived for subsequent viewings at: Outreach to three of NYS s major medical malpractice insurers, leading one carrier to feature SIPC materials at its annual network meetings with insureds, another featuring the campaign link on its risk management web page and the other convening a collaboration meeting with its infection control nurses. A five minute, patient empowerment video, Your Best Shot at Safety, with talking points for patients to discuss safe injections with their providers. The video can be viewed on YouTube at: A presentation to the NYS Board of Medicine regarding injection safety, including a proposal that they approach the Federation of State Medical Boards to request inclusion of an injection safety question on medical board exams in the future. Perinatal Hepatitis B Manual The NYSDOH Perinatal Hepatitis B Manual was revised and posted to the NYSDOH web site in May Additional sections were added to the manual to promote the Hepatitis B Hospital Birth Dose Initiative and improved case management through tracking in the Communicable Disease Electronic Surveillance System (CDESS). Training on the revised manual was provided in two webinars in The first webinar, Perinatal Hepatitis B Care of Mother and Newborn, targeted hospital staff and health care providers. The second, Perinatal Hepatitis B Case Management, was intended for local health department and NYSDOH regional staff. Both webinars were archived and can be viewed at: Page 7

11 Discharge Packets for Prison Inmates Being Released The AIDS Institute s Bureau of Community Based Services and Education and Training Section, in collaboration with the NYS Department of Corrections and Community Supervision s (DOCCS) Medical Office and Transitional Services Unit, continued to distribute health resource packets to inmates as they exit targeted DOCCS correctional facilities. These packets include a general health and human service resource guide, prevention information regarding HIV, STDs and hepatitis C and prophylactic barriers (male and female condoms). Packets include information in English and Spanish. In 2011, 6,000 health resource packets were distributed. 3. Surveillance and Research To determine the accurate hepatitis A, B and C incidence rates (and prevalence rates for hepatitis B and C) for use in conjunction with available research findings to guide decision making, the NYSDOH accomplished the following during 2011: Burden of Hepatitis C Virus in New York State AIDS Institute staff, in accordance with the approved Institutional Review Board (IRB) protocol, conducted a comprehensive assessment to estimate the prevalence and incidence of the hepatitis C virus (HCV) in New York State (NYS), including New York City (NYC), as well as to determine the current and future morbidity and mortality associated with hepatitis C. HCV antibody positivity (anti HCV) and chronic HCV prevalence were estimated by extrapolating prevalence from studies of special populations and the National Health and Nutrition Examination survey to the underlying size of NYS. The study found an estimated anti HCV prevalence of 1.95% (range: 0.96, 2.98) or 286,262 persons who have ever been infected with hepatitis C. The chronic hepatitis C prevalence was estimated to be 1.33% (range: 0.44, 2.31) or 194,705 persons currently infected with hepatitis C. Results of the incidence and morbidity and mortality assessments are being finalized and will be released in Continued Management of the Chronic Hepatitis Disease Registry The NYS Chronic Hepatitis Disease Registry, initiated in 2002, continues to be monitored by Bureau of Communicable Disease Control (BCDC) staff. As of December 31, 2011, the registry included more than 83,348 confirmed chronic hepatitis C cases and more than 11,420 confirmed chronic hepatitis B cases. The disease registry is now well established. Data are being used to monitor trends, detect outbreaks and provide epidemiological descriptions of those infected. Annual surveillance summaries are posted on the NYSDOH web site. In 2011, BCDC staff continued to improve registry data, distributed revised surveillance guidelines and provided training for local health departments. Enhanced Acute Hepatitis Surveillance Project In 2004, the NYSDOH Bureau of Communicable Disease Control was one of two sites awarded supplemental funding through CDC s Emerging Infections Program (EIP) to conduct enhanced acute hepatitis surveillance in two EIP regions of NYS (Western and Capital District). The purpose of this initiative was to develop model demonstration projects for enhanced viral hepatitis A, B and C surveillance Page 8

12 within the framework of the existing EIP, and increase case ascertainment of acute hepatitis cases, especially acute hepatitis C. The NYS project includes a participating local health department component and a participating laboratory component. The goals of the participating local health department component are to expand standard follow up activities for positive hepatitis laboratory reports; collect detailed clinical and risk factor information for all acute hepatitis cases; ensure complete and timely case reporting; and, ensure patient education and counseling for all acute hepatitis cases. The goals of the laboratory component are to conduct active, laboratory based surveillance; explore the feasibility of collecting serologic specimens for acute hepatitis A and B cases; and, explore the feasibility of linking liver enzyme results with hepatitis C test results to increase case finding of acute hepatitis C cases. Hepatitis surveillance officers have been assigned to these regions and serve as a resource for participating local health departments and assist with routine hepatitis surveillance activities, including case ascertainment, provider and patient follow up and case reporting. In 2011, the project continued. Funding has been extended through October The degree to which CDC will continue to support enhanced surveillance activities will be addressed in a new funding announcement expected to be published in spring Retrospective Review of Acute Hepatitis B among Adults with and without Diabetes The NYSDOH Bureau of Communicable Disease Control participated in a multi site retrospective review of acute hepatitis B cases reported between 2009 and Case reports for those meeting the CSTE confirmed case definition among persons older than age 23 were reviewed to determine completeness of select variables, including demographics, diabetes status and known risk factors (e.g., men who have sex with men [MSM], injection drug use [IDU] and multiple sex partners) for infection. A chart review and, if necessary, patient interview were conducted for incomplete case reports. The eight participating sites submitted a database to the CDC for analysis and reporting. Results of the study were presented at the 49 th Annual Meeting of the Infectious Disease Society of America and the HIV Medicine Association in Boston, Massachusetts on October 20 23, The results showed that estimates of acute hepatitis B incidence among adults with diabetes were more than twice as high as adults without diabetes. Data from this study were used in conjunction with results from other studies to develop recommendations for hepatitis B vaccination among adults with diabetes mellitus. The publication Use of Hepatitis B Vaccination for Adults with Diabetes Mellitus: Recommendations of the Advisory Committee on Immunization Practices (ACIP) was published in the CDC Morbidity and Mortality Weekly Report (MMWR), Volume 60, Number 50 on December 23, Hepatitis C Virus Clinical Test Applications The Wadsworth Center received five test approval applications from NYS permitted laboratories for new hepatitis C virus (HCV) clinical tests. All five applications were for HCV genotyping tests, including two for detecting drug resistance mutations related to the recently approved HCV protease inhibitors. Wadsworth staff reviewed the validation packages which include standard operating procedures, comprehensive validation studies, patient education materials and test reports. One new HCV test was Page 9

13 approved for clinical use by the NYSDOH and the other four required additional information from the submitting laboratory for further review. HIV Registry and Chronic Hepatitis Registry Match During 2009, a match of the NYS HIV/AIDS Registry with the NYSDOH Bureau of Communicable Disease Control s Chronic Hepatitis Registry was undertaken for hepatitis cases diagnosed through December 2007 in NYS outside of New York City. The purpose of this match was to determine the prevalence of co infection and to characterize demographic and risk factors among those co infected in order to better target resources for prevention and treatment. Results show that hepatitis C infection was documented in 54,044 persons, of which 4,493 (8.3%) were co infected with HIV. Of 7,780 hepatitis B cases, 624 (8.0%) were also infected with HIV. Both chronic hepatitis B and C infection were identified in 354 individuals; of these, 104 (29.4%) were also infected with HIV. A State University of New York (SUNY) Albany, School of Public Health doctoral student analyzed the registries match data on the co infected population. Analyses demonstrated differences in the residence at time of HIV diagnosis versus viral hepatitis diagnosis. This revealed that 18.7% of hepatitis B/HIV and 26% of hepatitis C/HIV co infected cases were diagnosed with hepatitis while residing in NYS and with HIV while residing in NYC. Additionally, the timing of HIV diagnosis versus hepatitis C confirmation was investigated. For the greater majority of cases (87%), the confirmation of hepatitis C was recorded after HIV diagnosis. Results of the analysis were presented on December 28, 2011 as a requirement of the internship. Prevalence and Transmission of Hepatitis C among HIV infected Childbearing Women Delivering in NYS In accordance with the approved Institutional Review Board (IRB) protocol, a study was conducted to assess the prevalence and transmission of hepatitis C among HIVinfected childbearing women delivering in NYS in This statewide population based study showed hepatitis C viral antibody seroprevalence of 3.8%. Maternal age of 35 years or older and injection drug use were the strongest predictors of seropositivity. Although no viral transmission was documented, more comprehensive longitudinal testing would be required to conclude that hepatitis C transmission did not occur. The findings of the study were presented in poster format at the Third North American Congress of Epidemiology from June 21 24, Hepatitis C and HIV/Hepatitis C Co infection in NYS DOCCS Since 2000, the Bureau of HIV/AIDS Epidemiology has studied the prevalence of HIV and HIV/hepatitis C co infection among NYS Department of Corrections and Community Supervision (DOCCS) inmates with the inclusion of hepatitis C antibody testing as a standard component of the HIV seroprevalence study. Systematic samples of consecutive inmates entering the DOCCS system were selected for cross sectional surveys in 2000, 2003, 2005, 2007 and The total study sample for is 15,856 with 3,293 (21%) records from female inmates and 12,563 (79%) from male inmates. For this time period, HIV prevalence declined from 4.7% to 3.0% in males and 13.9% to 10.7% in females, whereas hepatitis C prevalence declined from 13.4% to 11.2% in males and 23.1% to 15.7% in females. Page 10

14 From November 2009 to June 2010, the Bureau of HIV/AIDS Epidemiology conducted the fifth round of the HIV/hepatitis C seroprevalence study among DOCCS inmates. Data and specimens were collected from 4,355 inmates following the same methods used in previous cycles. The final 2009 study cohort contains 4,083 complete records, all with valid HIV and hepatitis C test results. Initial findings indicate a continued decline in HIV and hepatitis C positivity rates among study inmates, though analysis is ongoing. National HIV Behavioral Surveillance (NHBS) The Bureau of HIV/AIDS Epidemiology s Behavioral Surveillance System is part of a multi state survey of populations at high risk for HIV, with annually rotating cycles of data collection of men who have sex with men (MSM), injection drug users (IDU) and heterosexuals at increased risk for HIV. The study collects via in person interviews, timely and comprehensive information about sexual and drug use risk behaviors, HIV testing histories and exposure to and use of HIV prevention services. In NYS, the study is conducted within the Nassau and Suffolk County metropolitan statistical area. Since 2005, selfreported hepatitis immunization and testing history has been collected for all cycles. Data include interview records for: Two cycles of IDUs: IDU1 collected in 2005 (n=451) and IDU2 collected in 2009 (n=202); Two cycles of heterosexuals: Het1 collected in (n=678) and Het2 collected in 2010 (n=147); and, Two cycles of MSMs: MSM2 collected in 2008 (n=281) and MSM3 collected in 2011 (n=354). More than half of IDU participants (IDU1: 155%; IDU2: 58%) reported ever testing for hepatitis C, with the majority (60%) indicating their most recent test was administered more than one year prior to their NHBS interview. Of the target populations, IDUs had the highest rate of selfreported hepatitis infection. Twenty six percent (26%) of IDU1 and 33% of IDU2 reported ever being told by a health care professional that they had hepatitis. Hepatitis C was most commonly reported (90%), but nearly a quarter of IDU1 participants and 15% of IDU2 participants reported hepatitis B infection. Nearly one third of IDU1 and 40% of IDU2 reported ever receiving a hepatitis vaccine; the vast majority (80%) reported receiving the hepatitis A and B combination vaccine. Forty three percent (43%) of heterosexuals (Het1) and 37% of Het2 reported ever being tested for hepatitis C, with 60% and 70% respectively reporting that testing occurred more than one year prior to their NHBS interview. Only 3% of Het1 and no Het2 participants reported ever being told that they had hepatitis by a health care professional, with hepatitis C being the dominant (68%) infection reported. Forty four percent (44%) of Het1 and 32% of Het2 participants reported ever receiving a hepatitis vaccine, with 80% of Het1 and 78% of Het2 reporting they received hepatitis A and B combination vaccine. Similar proportions of participants in MSM2 and MSM3 reported access to and use of hepatitis health care and prevention services. Sixty percent (60%) of MSM2 and 63% of MSM3 reported ever testing for hepatitis C. Fifty five percent (55%) of MSM2 and 59% of MSM3 reported that Page 11

15 testing occurred at least one year prior to their NHBS interview. Only 8% (MSM2, n=20; MSM3, n=29) reported ever being told by a health care professional that they had hepatitis. Of those infected, MSM2 differed from MSM3 in that 50% (n=14) of MSM2 reported hepatitis A infection only, compared to 35% (n=10) of MSM3. Furthermore, nearly twice as many MSM2 participants (32%) reported exclusive hepatitis B infection than MSM3 (17%) participants. By contrast, the percentage of MSM2 exclusively reporting hepatitis C infection (4%, n=1) was far lower than that observed among MSM3 (34%, n=10). Nearly half of both samples (MSM2, 47%; MSM3, 44%) reported a history of hepatitis vaccination, with 56% and 69% respectively reporting receipt of combination hepatitis A and B vaccine. 4. Medical Care and Treatment To develop and maintain an infrastructure to provide the highest quality of hepatitis A, B and C care (and treatment for hepatitis B and C), the NYSDOH accomplished the following during 2011: Hepatitis C Continuity Program The AIDS Institute, NYS Department of Corrections and Community Supervision (DOCCS), New York City Health and Hospitals Corporation (HHC), Designated AIDS Centers (DACs) and other community based health care providers continued development of the Hepatitis C Continuity Program to assure continued access to hepatitis C treatment for inmates being released to the community. Meetings continued with DOCCS to discuss and revise the program protocols and other related materials. Expanding the Capacity to Provide Hepatitis C Care and Treatment During 2011, on site visits were conducted at all five programs that received funds to provide on site hepatitis C medical care, care coordination, treatment and supportive services in a primary care setting for hepatitis C mono infected persons. From October 2010 through September 2011, 490 new patients were enrolled in the programs, of which 61.8% were male and 36.1% were female. Of these, 68% were eligible for hepatitis C treatment and, of those, 27% initiated treatment. Most were between the ages of years old (41.8%). More than one third (36.3%) were Hispanic. The eight HIV primary care programs that received funds to provide these services for HIV/hepatitis C co infected persons provided services to 641 new patients; most were male (66.5%), Hispanic (39%) and older than age 50 (58.35%). The first annual Hepatitis C Best Practices Seminar was held for the 13 funded programs on March 30, The purpose of the meeting was to allow attendees to share information about their programs, including but not limited to successes and challenges, to network with other funded program staff and to learn from each other. More than 35 providers and program staff were in attendance. The meeting began with a presentation on new hepatitis C treatments in development. Best practice models shared at the meeting included Mt. Sinai s Patient Navigator Program and Albert Einstein College of Medicine s Hepatitis C Group Treatment Model. Page 12

16 Three provider webinars were held in 2011: New Challenges in Hepatitis C Treatment Adherence: Applying Lessons Learned from HIV Antiretroviral Treatment Adherence Research was presented by Jeffrey Weiss, PhD, MS, Assistant Professor in the Department of Medicine (Division of General Internal Medicine) at Mt. Sinai School of Medicine. Dr. Weiss discussed the similarities and differences between HIV and hepatitis C treatment adherence, challenges with hepatitis C treatment adherence and strategies to overcome those challenges. Dr. Weiss also included information on the new hepatitis C anti viral therapies and additional adherence issues related to these new therapies. Hepatitis C: Depression and Depression Screening, also presented by Dr. Weiss, provided a review of the research on the relationship between depression and hepatitis C treatment discontinuation and prophylactic use of antidepressants prior to hepatitis C treatment initiation. He also discussed assessment of depression in patients prior to and during hepatitis C treatment. Hepatitis and the Medicaid and Medicare Systems was presented by Frank Winter, Partnership Manager for the Centers for Medicare and Medicaid Services, New York Regional Office of External Affairs. The webinar covered Medicare and Medicaid fundamentals; updates on the Affordable Care Act and the NYS Medicaid redesign; hepatitis B and C special issues (e.g., prescription drug coverage); and, resources for resolving problems and issues. Hepatitis C Assistance Program (HepCAP) A large number of persons living with hepatitis C are either uninsured or underinsured. To ensure that these individuals have appropriate access to hepatitis C related medical services, AIDS Institute staff created the Hepatitis C Assistance Program ( HepCAP ) using the AIDS Drug Assistance Program (ADAP) as a model. The program serves NYS residents living with hepatitis C who are uninsured and who meet programestablished eligibility criteria. Services covered by HepCAP include initial hepatitis C medical and treatment evaluation and hepatitis C treatment monitoring. HepCAP does not cover the costs of antiviral therapy, but will assist clients with applying for patient assistance programs available through the two pharmaceutical companies that manufacture hepatitis C antiviral therapy. During its first full year of implementation (October 2010 September 2011), 14 clients enrolled in the program, including 11 from FQHCs and three from methadone maintenance treatment programs. ADAP staff provided ongoing technical assistance to programs regarding proper billing procedures. 5. Policy and Planning To foster an effective policy and planning environment for hepatitis A, B and C (as well as an effective regulatory environment for hepatitis B and C) at the local, state and national levels, the NYSDOH accomplished the following during 2011: NYS Viral Hepatitis Strategic Plan ( ) An online survey was developed and distributed to evaluate the implementation of the NYS Viral Hepatitis Strategic Plan ( ). Individuals completing the survey included those who provided input in developing the Strategic Plan, including consumer and provider advisory bodies, local health departments, NYS Page 13

17 government agencies, statewide immunization coalitions, medical provider associations, clinicians, community groups and consumers. The survey tool consisted of five major sections, one for each focus area of the Strategic Plan: prevention; education; surveillance and research; medical care and treatment; and, policy and planning. Each section included three questions to determine the strategies implemented by the respondents, accomplishments made and barriers encounters. A total of 186 individuals were asked to complete the survey and 38 individuals completed the survey, giving a response rate of 20%. The majority of respondents began implementing the Strategic Plan. Agency representatives responded that they favored strategies related to the prevention and education focus areas. Less work was being done to address the surveillance and research and policy and planning focus areas. Respondents identified more strategies being implemented for hepatitis C than hepatitis A or B. The same barriers were identified in implementing strategies for hepatitis A, B and C: insufficient funding, insufficient staffing and other competing priorities. Hepatitis Integration Work Group The NYSDOH Hepatitis Integration Work Group met quarterly in Topics discussed included the NYS Viral Hepatitis Strategic Plan ( ) evaluation; updates on the Hepatitis C Care and Treatment Programs; development of an internet based, 30 second video targeted to young people at risk for hepatitis C; hepatitis C rapid testing; and, hepatitis B and C transmission in health care settings. Program updates were also provided by the Adult Hepatitis Vaccination Program (AHVP), Bureau of STD Prevention and Epidemiology and the New York City Department of Health and Mental Hygiene s (NYCDOHMH) Office of Viral Hepatitis Coordination. Work group members include staff from the AIDS Institute, Hepatitis Surveillance Program, Bureau of Immunization, Wadsworth Center and NYCDOHMH. Hepatitis C Advisory Council The NYS Hepatitis C Advisory Council met on April 28, 2011 and October 6, Updates provided during the meeting included the NYS budget, hepatitis C rapid testing, the Medicaid Redesign hepatitis C proposal, Health Homes model of care coordination, updates on the Hepatitis C Care and Treatment Programs, the 2011 Hepatitis C Legislative Awareness Day, planning for the NYSDOH 2012 Statewide Viral Hepatitis Conference and the 2010 NYSDOH Hepatitis Integration Highlights report. Viral Hepatitis Community Work Group The Viral Hepatitis Community Work Group, formerly the Hepatitis C Community Workgroup, met quarterly in Work group members agreed to expand the goal and membership to include hepatitis B issues and representation from the hepatitis B community. This expansion will foster better coordination and increased communication about hepatitis B and C activities occurring at the state and local (including NYC) levels; increase the effectiveness of community activities when advocating for viral hepatitis; and, allow for ongoing dialogue between the NYSDOH and NYCDOHMH, and between the hepatitis B and C communities. Work group members identified several hepatitis B community members to invite to the June 2011 meeting. Members also launched a Twitter Page 14

18 account, HepatitisNY. Roles and responsibilities for the Twitter account were developed and four work group members volunteered to send Tweets on a regular basis. Collaboration with Community Health Center Association of New York State (CHCANYS) The AIDS Institute s Viral Hepatitis Section collaborated with the NYCDOHMH, Harm Reduction Coalition and CHCANYS to improve access to community health centers (CHCs) for hepatitis C screening, care and treatment, as well as harm reduction services for individuals engaging in high risk behaviors. Conference calls were held with CHCANYS to discuss developing a collaborative project to increase the number of CHCs providing hepatitis C services (i.e., screening, care, on site treatment and harm reduction services). A one day meeting was held on July 13, 2011 with chief medical officers, medical providers and other staff from several FQHCs in NYS and NYC. Fifteen health centers, including four of the AIDS Institute funded Hepatitis C Care and Treatment Programs (Hudson River Health Care, Anthony L. Jordan Health Center, Harlem United and Mt. Sinai Medical Center) participated. The purpose of the meeting was to discuss and develop a Hepatitis C Collaborative within FQHCs. The goal of the Hepatitis C Collaborative is to improve hepatitis C screening and diagnosis, as well as increase access to hepatitis C prevention services and improve linkages to hepatitis C treatment for at risk patients 18 years of age and older. The Hepatitis C Collaborative was presented at CHCANYS s annual statewide conference in October Funding to support the Collaborative is currently being sought. Conclusion The NYSDOH has effectively mobilized staff from a variety of program areas to work together on issues surrounding viral hepatitis. Review of program activities illustrates a consistent high level of attention to hepatitis throughout calendar year 2011 (Table 1). Activities during 2011 correspond to the overall goals and strategies of the NYS Viral Hepatitis Strategic Plan ( ) and staff are enthusiastic about continuing to work together across units and with consumer and provider advisory bodies, local health departments, other NYS government agencies, statewide immunization coalitions, medical provider associations, clinicians, community groups and consumers to advance the mission and vision of the NYS Viral Hepatitis Strategic Plan ( ). Page 15

19 Table 1. NYSDOH Viral Hepatitis Related Activities: 2011 Timeline January 2011 January 13, 2011 January 20, 2011 January 24, 2011 Hepatitis C Treatment Adherence Webinar Hepatitis C Hotline In service Lot Quality Assurance (LQA) training with Metropolitan Area Regional Office CDESS case management training with Westchester County January 26, 2011 January 27, 2011 February 2011 February 9, 2011 February 17, 2011 Hepatitis C Hotline In service Conference call with Medina Hospital staff regarding perinatal hepatitis B policy, procedure and birth dose initiative Hepatitis A and B Vaccination and the New York State Adult Hepatitis Vaccination Program webinar Long Island Hepatitis C Task Force kick off meeting Perinatal Hepatitis B statewide conference call March 2011 March 8, 2011 March 9, 2011 Hepatitis Integration Work Group meeting Hepatitis C Legislative Awareness Day Strategies for Implementing Hepatitis B Birth Dose presented at Good Samaritan Hospital Suffern, NY March 16, 2011 March 18, 2011 March 21, 2011 Perinatal Hepatitis B Program presented at SUNY Albany School of Public Health, Vaccinology Course Albany, NY Hepatitis C Community Work Group meeting LQA training with Metropolitan Area Regional Office, Part II Page 16