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The creation of the San Francisco Hepatitis C Task Force: a community response to a local epidemic

The creation of the San Francisco Hepatitis C Task Force: a community response to a local epidemic. Laura Thomas, MPA, MPH Drug Policy Alliance Task Force member Co-chair of Prevention, Education, Awareness & Treatment Committee Emalie Huriaux, MPH San Francisco Department of Public Health

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The creation of the San Francisco Hepatitis C Task Force: a community response to a local epidemic

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  1. The creation of theSan Francisco Hepatitis C Task Force:a community response to a local epidemic Laura Thomas, MPA, MPH Drug Policy Alliance Task Force member Co-chair of Prevention, Education, Awareness & Treatment Committee Emalie Huriaux, MPH San Francisco Department of Public Health Task Force co-chair Member of Prevention, Education, Awareness & Treatment and Research & Surveillance Committees

  2. Background • In SF, much like the rest of the country, there are significant gaps in hepatitis C prevention, education, testing, care, treatment, and surveillance services. • In response to these gaps, a group of community organizers requested that the Mayor appoint a task force to develop recommendations to strategically address the local hepatitis C epidemic. • Organizers worked for 1.5 years to establish the Task Force. • During that time they communicated with the Mayor’s liaison, garnered letters of support from stakeholders and community college students in a hepatitis course, and consulted with public health department personnel to outline existing efforts to address hepatitis C and how the Task Force could build on them.

  3. Timeline • Early 2008: Discussions began • May 2009: Mayor created Task Force • Nov 9th 2009: Inaugural meeting • Drug Policy Alliance agreed to be lead sponsor. • Secured grant from San Francisco Foundation • Grant mainly supports consultant to produce final report, along with printing of report. • Also supports limited Task Force expenses. • e.g., refreshments for meetings, website hosting

  4. Process • Identified potential categories of members and provided the Mayor’s office with a list. • Categories included: • People living with hepatitis C • Harm reduction advocates • Medical providers (including complementary providers) • Researchers • Formerly incarcerated • Once appointed (in November 2009): • Members developed bylaws. • Members voted for three co-chairs. • Members approved and joined committees. • Most of “the work” happened in committees.

  5. Task Force Vision • We envision a San Francisco where: • Everyone is educated about Hepatitis C (HCV) and has the opportunity to know their HCV status; • There are no new HCV transmissions; and • Everyone living with HCV receives the highest level of care and support to insure their quality of life and longevity.

  6. Task Force Goals • Promote better understanding about the impact of HCV on San Francisco and its residents. • Develop better surveillance and reporting of HCV. • Raise awareness regarding HCV on both the community and individual levels. • Improve access to care and support services and increase quality of life for people with HCV.

  7. Task Force Goals (con’t.) • Make HCV screening and testing widely available and accessible. • Promote partnerships among the public/private health care sector, community organizations, advocates, and individuals affected by HCV. • Identify existing assets and gaps in access to hepatitis C education, prevention, screening, testing, and care. • Serve as liaison and coordinate with the SF Hep B Free Coalition to address common issues and strengthen partnership between hepatitis C and B advocates.

  8. Task Force Composition • Three co-chairs • Committees (each with an elected chair): • Care & Treatment • Prevention, Education, Awareness & Testing • Public Policy • Research & Surveillance • Steering (made up of Task Force co-chairs, chairs of each committee and two “at large” members)

  9. Process for developing recommendations • Expert presentations on diverse topics, for example: • State viral hepatitis plan • Veterans • Young IDUs • Leather/kink community • Community forums: • HIV/Hepatitis C Co-infection & Sexual Transmission of Hepatitis C • June 7, 2010 - Eureka Valley Recreation Center in the Castro District • Over 40 people • Hepatitis C in the African American Community • October 20, 2010 - City College of SF’s Southeast Campus • Over 50 people

  10. Recommendations Document • Currently in draft form. • Will be finalized in December 2010. • Contains approved recommendations from each committee pertaining to: • Care & Treatment • Prevention, Education, Awareness & Testing • Public Policy • Research & Surveillance

  11. Care & Treatment Recommendations • Strategic Direction: • To improve health outcomes of people living with hepatitis C (HCV) in SF. • Practical Vision: • Improved Case Finding Measures. • Expanded Capacity to Provide Care and Treatment. • Standardized Evaluation Procedures. • Expanded Access to Care and Treatment. • Improved Maintenance Care. • Enhanced Supportive Services.

  12. Prevention, Education, Awareness & Testing Recommendations • Strategic Directions: • To educate the public and providers about HCV. • To increase HCV testing. • To provide accurate risk information and effective HCV prevention interventions. • Practical Vision: • Increased public knowledge and understanding of HCV, transmission risks, health complications, and prevention strategies. • Increased provider knowledge and skills in HCV prevention, screening, care, and referrals. • Everyone is SF knows their HCV status and transmission risks. • Increased testing availability, including rapid tests. • Increased understanding of HCV transmission risk among medical providers, service providers and the general public. • Adequate resources and funding to carry out HCV testing, counseling and education. • Shared understanding of HCV transmission risks. • Increased access to effective prevention interventions and services.

  13. Public Policy Recommendations • Strategic Directions: • Improve SF’s response to the hepatitis C epidemic through funding, legislative, and policy strategies and initiatives • Leverage SF’s influence at state and federal levels to secure legislation and funding to address HCV epidemic in California and the United States • Practical Vision: • Establish HCV coordinator at SFDPH. • Establish/coordinate HCV community planning council. • Support/sustain integration of HCV programs into existing city health care services. • Sufficient funds for Healthy SF for HCV testing, care, treatment. • Funding for expanding patient navigators/benefits counselors. • HCV research section in SFDPH. • Establish pilot supervised injection facility. • Lead nation in establishing drug policies that address drug use as public health issue. • Support efforts to change California/national drug policy. • SFDPH policy should support HCV treatment for active substance users who choose to engage in treatment, in coordination with medical provider.

  14. Public Policy Recommendations • Practical Vision (con’t): • Fully fund comprehensive range of substance use programs. • Ensure community standard of HCV care for those incarcerated/in criminal justice system. • Continuity of care for people with HCV upon release from jail/prison who are returning to SF. • Ensure needs of people with and at risk for HCV are met through HCR implementation. • Ensure care/treatment for those not included in healthcare reform, including undocumented. • Vigorously oppose efforts to repeal/weaken healthcare reform. • New/innovative ways to negotiate with pharmaceutical companies for grant funding and patient assistance programs. • Negotiate/advocate for best pricing of HCV treatment. • Partner with foundations/philanthropic organizations to secure HCV funding.

  15. State-level Policy Recommendations • Direct City’s Sacramento lobbyist to prioritize advocacy on state hepatitis legislation, policy, funding. • Direct City’s lobbyist to advocate for implementation of the California Adult Hepatitis Strategic Plan. • Urge City’s reps in State Legislature to champion hepatitis funding/legislation.

  16. Federal-level Policy Recommendations • Direct City’s lobbyist in Washington, DC to advocate on federal hepatitis legislation, funding, policy • Urge Bay Area’s reps in Congress to champion hepatitis issues • Urge Congress to remove all restrictions on federal funding for syringe exchange and to provide funding streams for exchange programs

  17. Research & Surveillance Recommendations • Strategic Direction: • An accurate epidemiological profile of hepatitis C morbidity and mortality in SF. • Advancement of hepatitis C research and development of prevention, care and treatment in SF. • Practical Vision: • Develop, compile and share hepatitis C surveillance data and generate SF-specific surveillance reports. • Engage medical providers, healthcare organizations, laboratory staff and SFDPH personnel to evaluate, modify as needed, and implement viral hepatitis reporting requirements to improve quality and use of viral hepatitis surveillance data. • Increase acute HCV surveillance capacity. • Increase chronic HCV surveillance capacity. • Support HCV research & development.

  18. Examples of Recommendations Grounded inHarm Reduction Principles & Practice • Provide accurate information about the sexual transmission of HCV. • Compile and disseminate accurate information about sexual transmission of HCV. • Hold community forums to provide accurate information about HCV, including sexual transmission, in the BDSM, kink, and LGBT communities. • Create an educational campaign focused on HCV to better educate relevant communities on HCV sexual acquisition and transmission. • Train medical providers, service providers and health care providers on the transmission of HCV including sexual transmission. • Increase education on the dual diagnosis of HIV and HCV. • Provide consistent information and messages on uncertain information regarding HCV.

  19. Examples of Recommendations Grounded inHarm Reduction Principles & Practice • Increase access to sterile injection equipment and other harm reduction services. • Expand and fund syringe access programs including satellite syringe access programs towards the goal of every IDU having a sterile syringe per injection event. • Increase access to syringes and other injection equipment (e.g., cookers, cottons, water) in primary care clinics, HIV prevention programs, drug treatment programs, mental health clinics, drop-in centers, mobile health vans, and other settings serving IDUs. • Encourage all pharmacists to participate non-prescription syringe sales programs. • Remove any structural or legal barriers to access to syringes and other sterile equipment for drug users. • Support and fund the creation of a supervised injection facility in SF. • Increase syringe disposal access throughout SF. • Provide sterile split kits. • Provide sterile drug using equipment for non-injection drug use. • Decriminalize the possession of drug use equipment and paraphernalia. • Increase education of law enforcement staff about syringe access programs. • Support research on heroin assisted treatment. • Expand overdose prevention programs and eliminate legal/structural barriers to greater distribution of naloxone and other overdose fatality prevention measures. • Address misconceptions regarding HCV in the IDU community by providing accurate information at programs serving IDUs.

  20. Successes • Convening meetings with a diverse group of stakeholders and developing a set of comprehensive recommendations for strategically addressing HCV in San Francisco. • World Hepatitis Day Rally & Press Conference (May 19th) garnered a lot of press about the Task Force and HCV in SF. • Engaging specific communities through community forums and outreach efforts. • Gaining insight and information from a variety of experts.

  21. Challenges • “Sunshine” Ordinance • Set of regulations about how public meetings must be conducted. • Requires posting of agendas 72-hours in advance of meetings. • Prohibits electronic conversations, conference calls and impromptu meetings. • Maintaining quorum at every meeting in order to approve voting agenda items. • Mayor is becoming Lieutenant Governor, so unsure about who we will give these recommendations to at the end of the year.

  22. Next Steps • What to do in 2011? • Remain a Task Force affiliated with the Mayor’s Office? • Become an independent community advocacy group, focused on overseeing implementation of recommendations? • Try to become a community planning council, in partnership with SFDPH? • Something else?

  23. For More Information: • Visit • www.hepcsf.org • Email • info@hepcsf.org

  24. mayor's HEPATITIS C task force Thank You To: Mayor's LiaisonsAlex Randolph & Nick PanagopoulosConsultantPat Dunn MembersAlice AsherShirley BargerRose ChristensenRyan ClaryMisha CohenJane DalugduganJenna FerraraAlan FranciscusTodd FrederickIsela GonzalezNina Grossman Brad Hare Co-ChairsRandy AllgaierEmalie HuriauxDominique Leslie Theresa HughesLinette MartinezRodney McClainAndrew ReynoldsClayton RobbinsJim Row Robin RothJim StillwellLaura ThomasJorge VietoCarla Wilson

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