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Texas Hepatitis C Initiative

Texas Hepatitis C Initiative. National Hepatitis Coordinators Conference San Antonio, TX January 2003 Gary Heseltine MD MPH Infectious Disease Epidemiology and Surveillance Division Texas Department of Health. House Bill 1652 Rep. Maxey, Danburg, Ehrhardt, Copelo, and McClendon.

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Texas Hepatitis C Initiative

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  1. Texas Hepatitis C Initiative National Hepatitis Coordinators Conference San Antonio, TX January 2003 Gary Heseltine MD MPH Infectious Disease Epidemiology and Surveillance Division Texas Department of Health

  2. House Bill 1652Rep. Maxey, Danburg, Ehrhardt, Copelo, and McClendon • Conduct seroprevalence survey to determine magnitude and scope of HCV infection. • Develop training course for HCV counselors. • Establish voluntary HCV testing centers in each public health region - HIV/STD sites. • Promote public and professional education, awareness, and training on HCV. • Effective September 1, 1999

  3. Reporting of Hepatitis C • Board of Health adopted new reporting rules for HCV in 2000. • All newly diagnosed cases of HCV are reportable beginning 01/01/2000. • Reporting is done in the same manner as before for acute hepatitis. • Change from 350 acute to more than 20,000 newly diagnosed cases per year

  4. Texas Year 2000 Population • 20,500,000 residents • Prevalence of HCV infection: 1.8% • Estimated infections: 366,000 • Occurrence of chronicity: 85% • Estimated chronic infections: 310,000

  5. Texas Year 2000 Ethnicity

  6. Coordinating State Activities • HIV/AIDS Interagency Coordinating Council • HB 768 – council mandate expanded in September 2001 to include hepatitis, 19 member agencies • SB 338 – call for the development of a state plan for HCV, recently completed • Proposed: Interagency Council for Immunizations • Goal: integrated services/linked infrastructure: HIV/STD, Immunizations, and hepatitis (TB?).

  7. Educational Activities: Professionals • Training video and hepatitis module developed for PCPE counselors – ongoing statewide training • One- and two-day CME/CNE courses for health care workers - twice a year through UTSWMC • Texas Medicine and Texas DO articles • Exhibits at professional meetings, mailings, web info • HB 2650 – requires 2 contact hours of HCV training for RN’s renewing their licenses, many offer such training • Training also mandated for LCDC’s

  8. Summary HCV Seroprevalence Studies

  9. Austin-Travis County – CDC Demonstration Project 2000n = 1619

  10. David Powell Clinic • 281 new HIV+ patients in 2000 • 68 HCV+, 24% • 18 of HCV+ patients (26%) normal LFT • Screen with a hepatitis panel not LFTs.

  11. HCV in Prisons: TDCJ Study • Population 157,000 • Overall seroprevalence on admission 29% • Males 28% and females 37% • 45,000 individuals with chronic HCV • 53% have evidence of past HAV infection • 56% have evidence of past HBV infection • 2.7% have chronic HBV infection • HBV vaccination for all inmates • Addressing risk behaviors - peer counselors

  12. Proposal: HCV Integration with Perinatal HBV Program

  13. HCV Counseling and Testing Sites Submitters – 50 PCPE Contractors - 21

  14. I wish they would print clearly!

  15. Optical Density versus RIBA Results

  16. Describing HCV Clients

  17. Counseled? Tested?

  18. Counseling & Testing SitesPositivity Rate by Race/Ethnicity

  19. Counseling and Testing Sites

  20. HCV Positives • 85% were results counseled • 47% were referred to treatment • 7% had confirmed referral to treatment • 15% were referred for immunization • 2% had confirmed referral for immunization

  21. Media Campaigns Pre- and Post-Surveys • Hep C awareness increases • Valley, 23% to 75% • San Antonio, 34% to 63% • East Texas, 59% to 93% • Specific content recall • 85% in Valley • 70% in San Antonio • 34% in East Texas • Hepline – 866-4HEPABC

  22. Next? Healthy People 2010 Goal - incidence 1/100,000 • HCV prevalence in IDU’s as a barometer of success • On stop shopping for services, co-infections HIV, TB • Continuity of services between prisons and community, Public Health as a facilitator • Integration of HCV into perinatal HBV program • Incorporation of HCV specific items into BRFSS • Integration of HCV and BBP messages into school health programs • Developing partnerships – CBO’s, FBO’s, and others to achieve goals

  23. Hepatitis C Activities in Texas: A Work in Progress Kate Hendricks, MD, MPH&TM; Gary Heseltine, MD, MPH; Kathi Shupe-Ricksecker, PhD; Alma Thompson; Sharon Melville, MD; Casey Blass, Celine Hanson, MD; Rose Brownridge, MD; Sharilyn Stanley, MD; Terri Garcia; Pat Cox, PhD; Elizabeth, PhD; Bruce Elliott, PhD

  24. Test Core NS3 NS4a,b NS5a,b EIA 2 c22-3 c33c c-100-3 RIBA 2 c22-3 c33c c-100-3 5-1-1 EIA 3 c22-c c33c c-100-3 NS5 RIBA 3 c22-P c33c c-100P NS5 EIA and RIBA Antigens

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