HCV Testing and Linkage to Care in California · STD Control Branch HCV Testing and Linkage to Care...
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STD Control Branch HCV Testing and Linkage to Care in California Rachel McLean, MPH California Department of Public Health (CDPH) NASTAD TA Meeting, Washington, D.C. November 29, 2017 DRAFT
Transcript of HCV Testing and Linkage to Care in California · STD Control Branch HCV Testing and Linkage to Care...
STD Control Branch
HCV Testing and Linkage to Care in California
RachelMcLean,MPHCaliforniaDepartmentofPublicHealth(CDPH)
NASTADTAMeeting,Washington,D.C.November29,2017
DRAFT
STD Control Branch
The Problem: Most People with Hepatitis C are Not Diagnosed,
Linked to Care, Treated or Cured
0%
20%
40%
60%
80%
100%
AllHCVchronicallyinfected
HadHCVdetected
Werereferredto
care
Hadinfectionevaluated
Weretreated
Werecured
Source:Holmbergetal.,NEnglJMed2013
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Sources of New HCV Infection, 1995-2000
*Inamedicalsetting;healthcarework,perinatal
Previously Acquired ( <1990s )
Transfusion10%
Sexual18%Other *
Unknown9%
Injection Drug Use68%
Unknown10% Other *
1%
Sexual15%
Injection Drug Use60%
OccupationalOccupational
4%
Newly Acquired ( 1995-2000 )Previously Acquired ( <1990s )
Transfusion10%
Sexual18%Other *
Unknown9%
Injection Drug Use68%
Unknown10% Other *
1%
Sexual15%
Injection Drug Use60%
OccupationalOccupational
4%
Newly Acquired ( 1995-2000 )
1%4%
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People with Hepatitis C Who Inject Drugs Face Barriers to Care
Transportation
HealthCoverage/Literacy
Stigma/Shame
Homelessness
LackofID
Hunger
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• $2.2M/yearfor3yrs.• 3Goals:
1) UsingsurveillancetoimproveHCVoutcomes2) HCVtestingandlinkagestocare3) HCVcarecoordination
• 5Sites:1) ButteCountyDPH(Goal1)2) AccessSupportNetwork(Goal2)3) SanFranciscoDPH(Goal2andGoal3)4) FamilyHealthCentersofSanDiego(Goal2and
Goal3)5) St.John’sWellChildCenter(LA)(Goal3)
Hepatitis C Testing and Linkage to Care Demonstration Projects
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Goal 2: Community-Based HCV Testing and Linkages to Care
(RuralAIDSServiceOrganization)
(Urbanmulti-servicecenter,syringeexchangeprogram,SanFrancisco’sTenderloinDistrict)
(UrbanFederallyQualifiedHealthCenter,syringeexchange
program,HIV/HCVclinic)
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What Does HCV Testing & Linkage to Care Mean, Really?
*MediacampaignsdesignedbypeoplelivingwithhepatitisCandpilottestedwithpeoplewhoinjectdrugs(PWID)*Outreach onthestreets,underbridges,alongriverbanks,inshelters,drugtreatment,atsyringeexchange,atfoodpantries,etc.
STD Control Branch
What Does HCV Testing & Linkage to Care Mean, Really?
* HCVrapidtestingatsyringeexchanges,onmobilevans,atdrugtreatmentprograms
* PhlebotomytodosamedayHCVRNAtesting,includinggettingHCVtestcounselorscertifiedasaphlebotomist;CLIAcertificateofwaiver
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What Does HCV Testing & Linkage to Care Mean, Really?
* Collectingextensivecontactinformation
* Keepingtrackofclientswhentheyarearrested,hospitalized,deported,injail
* Maintaininganopendoorpolicyincasepeopleshowuplater
Source:UCSFVIPStudy
STD Control Branch
What Does HCV Testing & Linkage to Care Mean, Really?
* Patientnavigation,includinghelpgettingID,benefitsenrollment,reminders,transportationto—andincentivesforattending—keyappts.
* Patienceandpersistence;kindnessandnon-judgment
STD Control Branch
What Does HCV Testing & Linkage to Care Mean, Really?
* Paidstaff/peers:HCV-specificnavigatorsforoutreach,HCVtesting,navigation,phlebotomy;projectmanager;dataanalyst!
* CulturalcompetencewithPWIDandco-locationofservices—bringingtestingtowherePWIDhangout
STD Control Branch
HCV Testing Outcomes in Community-Based Settings, Goal 2 Sites, March 2016 – September 2017
Non-IDU44%IDU
56%
ClientsScreenedforHCVantibodybyInjectionDrugUse(IDU)Status
Total:3,693
STD Control Branch
HCV Testing Outcomes in Community-Based Settings, Goal 2 Sites, March 2016 – September 2017
0
100
200
300
400
500
600
700
800
900
1000
Anti-HCVpositive
ReferredtoRNAtesting
CompleteHCVRNAtesting
HCVRNApositive
ReceivedHCVRNAresult
Referredtomedicalcare
Attendedfirstappointment
IDU Non-IDU
87%
76%
74%
76% 93%
58%
*Percentagesshownarecalculatedasaproportionofthepreviousbar.
STD Control Branch
HCV Testing and Linkage to Care Project Outcomes, California, Goal 2 & 3 Sites, March 2016 – September 2017
1 KnownIDU:IDUstatusisunderestimatedforbecausetwoclinicalsiteswereunabletoconsistentlycollectinjectiondrugusestatus.2 Linkedtocare:DefinedasattendingfirstHCVmedicalappointmentforGoal2sitesandasstartingtreatmentforGoal3sites.3 CompletedTreatment:Thisnumberisanunderestimate,asGoal2sitesdonotcurrentlyreportthisdatatoCDPH.4 ReceivedSVRTestingandAchievedSVR:Thisnumberisanunderestimate,asGoal2sitesdonotcurrentlyreportthisdatatoCDPHandbecauseGoal3sitesreportthatclientscompletemedicationbutmaynotreceivetestingtoconfirmthattheyhaveachievedSVR.
AllClients(Goal2andGoal3)
Known toHaveEverInjectedDrugs1
%Among ThoseServedWhoReportedEverInjectionDrugs
TotalScreenedforHCVAntibody 28,417 2,895 10%HCVAntibodyPositive 2,154 1,147 53%TotalTestedforRNA 1,914 943 49%RNAPositive 1,554 737 47%LinkedtoCare/ReceivingClinicalCareManagement2 623 443 71%CompletedTreatment3 344 211 61%ReceivedSustainedVirologicResponse(SVR)TestingandAchievedSVR4 208 129 62%
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What Does It Take to Support Local HCV Demo Projects?
* Dedicatedfunding!* $1.7Mgrants;$400Kstate-levelpersonnel
* Programmanager(me)* StafftodoTA(2)* KnowledgeofHCV,drugtreatment,harmreductionlandscape
* Evaluatortododatacollection,QA(had1butneeded2!)
ChristineRodriguez,MPHProgramAdvisor
SusanaTat,MPHProgramAdvisor
PatriciaZialcita,MPHProgramEvaluator
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Awesome Grantees!
• FamilyHealthCentersofSanDiego– ElizabethEstrada,ShannonHansen,ChristianRamers,SandraReal,LettyReyes
• LosAngelesCommunityHealthProject– MichaelMarquesen,ShoshannaScholar,AimeZuniga
• SanFranciscoDepartmentofPublicHealth– KatieBurk,ColleenLynch,AaronSmith,PauletteWalton
• St.John’sWellChild&FamilyCenter,LosAngeles– VictorConstantino,VictorMartinez,PaolaRamirez,JoseRodriguez,PattiWagonhurst
• TarzanaTreatmentCenters,LosAngeles– YolandaCeballos,InnaLemeshko,JimSorg,KimberlyWard
STD Control Branch
How Does this Relate to the Hepatitis Care Cascades Grant?• Interventionpartnerships– “Leveraging”existingresources• HCVdemonstrationprojectsitesubcontractor• HCVtestkitspurchasedwithone-timestatefunds• StateMATexpansiongrantsrequireHIV/HCVtesting
– Policyintervention/performancemeasure• ProportionofPWIDscreenedforHCVannually
– Providereducation• TrainingHCVtestingandlinkagetocarebestpracticesforHCVtestkitandSAMHSAMATexpansionsites
Key:MAT=medicationassistedtreatment
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Resources* EndHepCSFAwarenessCampaignMaterialshttp://www.endhepcsf.org/campaigns/* CaliforniaHepatitisAlliance,HCVlinkageresourceshttps://calhep.org* DHCSMedicationAssistedTreatmentExpansionGrantshttp://www.dhcs.ca.gov/individuals/Pages/State-Targeted-Response-to-Opioid-Crisis-Grant.aspx* DHCSDrugMedi-CalOrganizedDeliverySystemhttp://www.dhcs.ca.gov/provgovpart/Pages/Drug-Medi-Cal-Organized-Delivery-System.aspx* HepatitisCOnlinehttp://hepatitisc.uw.edu* DHCSHCVTreatmentPolicy– prioritizesPWIDhttp://www.dhcs.ca.gov/Pages/HepatitisC.aspx
STD Control Branch
Contact Information
RachelMcLean,MPHChief,OfficeofViralHepatitisPreventionSTDControlBranchCaliforniaDepartmentofPublicHealthP:(510)[email protected]://cdph.ca.gov/ovhp
