Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV...

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Viral Hepatitis Testing Initiative - Sharing Results March 11, 2014

Transcript of Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV...

Page 1: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Viral Hepatitis Testing Initiative - Sharing Results

March 11, 2014

Page 2: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Mission NASTAD strengthens state and territory-based leadership,

expertise and advocacy and brings them to bear on reducing the incidence of HIV and viral hepatitis infections and on providing care and support to all who live with HIV/AIDS and viral hepatitis.

Vision NASTAD’s vision is a world free of HIV/AIDS and viral hepatitis.

Who is NASTAD?

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Table of Contents

Testing Initiative Overview

Presentations by Grantees

– Denver Health and Hospital Authority, Denver, CO – Alia Al-Tayyib

– MedStar Research Institute, Washington, DC – Dawn Fishbein

– Ohio Asian American Health Coalition, Columbus, OH – Manju Sankarappa

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Viral Hepatitis PPHF Testing Initiative

Established in FY2012, out of the Prevention and Public Health Fund

$6.7 million to 32 grantees in the following categories:

– HBV identification and linkage to care among foreign-born persons (9)

– HCV identification and linkage to care among people who inject drugs (10)

– HCV testing and linkage to care at community health centers (7)

– Project ECHO sites (2)

– HCV testing and linkage to care in other settings (7)

Continued in FY2013 through Secretary Transfer

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PCSI in Practice: Fully Integrated Screening for

HCV in an STI Clinic

March 11, 2014

Viral Hepatitis Testing Initiative Webinar

Alia Al-Tayyib, PhD and Laura Ginnett, MNM

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Testing Site

Denver Metro Health Clinic

Largest STI clinic and HIV testing facility in Rocky Mountain region with

approximately 18,000 visits annually

Free and confidential STI, HIV, and HCV testing, counseling, and treatment

(sliding fee scale implemented January 2014)

Family planning services (Title X clinic)

Immunization services (HPV, HBV, HAV)

Established HIV Linkage to Care program (LTC)

Electronic medical record system (HealthDoc®)

Operates using a physician extender model: employs an 12-person clinical

staff and a 3-person clerical staff, supervised by a nurse manager and clinic

administrator, with daily medical activities supervised by one of 7 attending

physicians

Clinic housed within Denver Public Health, part of Denver Health

and Hospital Authority

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Testing Protocol

1. During triage, all patients are asked a standard set of questions

related to HCV risk

2. If a patient has any risk factors, they are offered a free HCV rapid

antibody test

3. If the patient agrees to testing, two purple top tubes of blood are

drawn (similar to HIV protocol)

4. The patient then sees a provider for their clinic visit. During the

visit, the provider discusses the patient’s risk factors and delivers

the HCV rapid test results to the patient

5. If the patient has a non-reactive rapid result, their visit concludes

6. If the patient has a reactive rapid result:

A Linkage to Care counselor is paged to meet with the patient

A blood specimen is processed for quantitative RNA testing at the Denver

Health Microbiology Lab

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HCV Screening Questions

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Screening Tracking

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Testing Outcomes

# of persons with HCV antibody result 2,857

# of persons with documented risk factor 2,491 (87%)

# of persons with documented counseling 1,326 (46%)

# of persons with positive HCV antibody 58 (2%)

# of persons with HCV RNA result 54 (93%)

# of persons with positive HCV RNA 32 (59%)

Denver Metro Health Clinic, January 1 - December 31, 2013

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Demographics by HCV antibody status

Total n (%)

HCV Anti- n (%)

HCV Anti+ n (%)

X2 p-value

Gender

Male 2,068 (72) 2,041 (73) 27 (47) <0.001

Female 789 (28) 758 (27) 31 (53)

Race/ethnicity

White, non-Hispanic 1,280 (45) 1,259 (45) 21 (36) 0.665

Black, non-Hispanic 507 (18) 495 (18) 12 (21)

Hispanic 873 (30) 854 (31) 19 (33)

Other/unknown 197 (7) 191 (7) 6 (10)

Health insurance

Uninsured 2,486 (87) 2,441 (87) 45 (78) 0.051

Public 349 (12) 336 (12) 13 (22)

Private 16 (0.6) 16 (0.6) 0

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Risk Factors by HCV antibody status

Total n (%)

HCV Anti- n (%)

HCV Anti+ n (%)

X2 p-value

Born 1945-1965 536 (19) 503 (18) 33 (57) <0.001

Ever injected 140 (5) 116 (4) 24 (44) <0.001

Shared intranasal supplies 713 (27) 692 (26) 21 (38) 0.051

Unprofessional tattoo 597 (23) 580 (22) 17 (31) 0.140

HCV+ sex partner 81 (3) 71 (3) 10 (20) <0.001

MSM activity 822 (29) 818 (29) 4 (7) <0.001

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HCV Linkage to Care

Leverage existing HIV LTC program

Staffed by 2.5 FTE, supervised by a LCSW

One person on-call during business hours

24 hour voice mail, calls returned next business day

All patients with a reactive HCV rapid test are offered a

meeting with an LTC counselor

LTC counselors meet with patients and provide them with

education about hepatitis C, ways to prevent the spread of

hepatitis C, ways to live with hepatitis C, and treatment options

for hepatitis C

LTC counselors schedule a follow-up phone call or meeting

with patients to deliver HCV RNA results and referral

information

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HCV LTC cascade from DMHC

52/53

Green lines denote CDC benchmarks

51/53 32/52 21/32 19/32

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Lessons Learned

Obtaining buy-in from clinic staff is critical

Drawing blood for HCV RNA at initial visit very helpful

Leveraging existing HIV linkage program is efficient way to

provide linkage services for HCV positive clients

Limited access to primary care providers creates difficulty for

linkage

Follow-up with STI clinic patients can be challenging

Screening in STI clinic provides opportunity for HCV education

and counseling for at-risk persons

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Acknowledgements

Prevention and Public Health Fund (1U51PS003805-01)

and CDC grants (3U51PS003805-01W1)

Denver Metro Health Clinic and LTC staff

Jeffrey Eggert Suzie Hunt-Fraizer

Melissa Edel Elizabeth Sanchez

Julia Weise Leslie Sotelo

Berlissa Abel Arley Tarin-Gonzalez

Anthony Abeyta Michael Fuhriman

Deborah Bell Alex Delgado

Pamela Berg Roberto Esquivel

Jessica Cabrera Maria Velesco

Kari Ehmann Diana Roble Madera

Valeria Escalera Tatiana Shimchenok

Lynn Hoskins Molly Weber

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Questions?

Principal Investigator

Alia Al-Tayyib

[email protected]

303-602-3601

Project Coordinator

Laura Ginnett

[email protected]

303-602-3609

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High Hepatitis C Infection Rate in Birth

Cohort Testing of an Urban, Primary Care

Clinic Population

Dawn Fishbein, MD

MedStar Washington Hospital Center MedStar Health Research Institute NASTAD Webinar March 11, 2014

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CDC and USPSTF (B) recommend that all persons born between 1945-1965 (“Birth Cohort”) be tested HCV infection at least once. 27% of population, 81% of all HCV US infection; 73% of HCV related mortality 3.25% prevalence rate in this age group, five times higher than among adults

born in other years 8% AA men 45% do not report any risk factors 31.5% do not have health insurance Alcohol use: 57% who drink, moderate to heavy

HCV in US populations are 3x > HIV

Washington, DC (DC) has reported rates of 2% for HCV and 2.6% for HIV.

We hypothesized that HCV testing in a large, urban primary care clinic, regardless of ascertainment of risk factors, will reveal higher rates than those previously published in DC and in the US.

Background

MMWR, Aug 2012, Vol 61 (4)

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Source: WHO

HCV – Global Distribution

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December 2012, established HCV testing in the Primary Care Clinic at MedStar Washington Hospital Center, with CDC grant funding (HepTLC).

The aim was to sequentially test in the Birth Cohort, link directly to care with ID or GI, and create a sustainable testing program.

Eligibility:

born between 1945-1965

without predetermined risk factors in the electronic medical record

not previously HCV tested or positive.

HCV antibody positive patients were linked to care regardless of RNA status to receive either further testing and evaluation, or if RNA negative, health education and counseling.

Data are reflected for testing through February 14, 2014.

Methods

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Tested

Birth

Cohort

Total

HCV Ab+

Intragroup

HCV Ab+

(n=1412)

(%)

(n=116)

(%)

116/1412

(8.2%)

Mean Age +

SD 58.7 + 5.7 60.0 + 4.9

Gender

Men 485 (34.4)

66

(56.9)

66/485 (13.6)

Women 927 (65.7)

50

(43.1)

50/927 (5.4)

Race/

Ethnicity

Black or

African

American

1237

(87.6) 107 (92.2)

B/A

A

Men

4

1

1

(

3

3

.

2

)

5

8

(

5

4.

2

)

58/411 (14.1)

B/A

A

Wo

men

8

2

6

(

6

6

.

8

)

4

9

(

4

5.

8

)

49/826 (5.9)

White,

non-

Hispanic

105

(7.4)

3

(2.6)

3/105

(2.9)

American

Indian or

Alaskan

Native

19

(1.4)

3

(2.6)

3/19

(15.8)

Asian

16

(1.1)

2

(1.7)

2/16

(12.5)

Insurance

Public 844 (59.8)

87

(75.0)

87/844 (10.3)

Private 568 (40.2)

29

(25.0)

29/568 (5.1)

Weekly reporting Input Provider popups in EMR

Patient presents to PCC Seen by MD

Venipuncture; counseling & literature provided

Anti-HCV Ab - : results by Provider/testing team

Anti-HCV Ab + and

RNA+ (Linkage)

Pt counseled on result given expedited appt to

Hepatitis Clinic for evaluation

Orasure rapid testing (fingerstick); counseling &

literature provided

Orasure + (Linkage)

Confirmatory RNA sent same day

Pt counseled on result given expedited appt to

Hepatitis Clinic for evaluation

Orasure - : Results provided and pt counseled on harm

reduction

Weekly reporting Input Provider popups in EMR

Patient presents to PCC Seen by MD

Venipuncture; counseling & literature

provided

Anti-HCV Ab - : results by Provider/testing

team

Anti-HCV Ab + and/or

RNA+ (Linkage)

Pt counseled on result given expedited appt to

Hepatitis Clinic for evaluation

Orasure rapid testing (fingerstick); counseling

& literature provided

Orasure + (Linkage)

Confirmatory RNA sent same day

Pt counseled on result given expedited appt to

Hepatitis Clinic for evaluation Orasure - : Results

provided and pt counseled on harm

reduction

Methods

Page 23: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Total Flagged n=5497 (%)

Total Tested 1412 (25.7)

Total Positive 116 (8.2)

*Linked to Care 99 (85.3)

**Seen at Appointment

80 (80.8)

Missed (not tested) 1442 (26.2)

Canceled & No Show

2643 (48.1)

HCV RNA+ 57 (71.3)

*Number of patient appointments with either Infectious Disease or Gastroenterologist,

regardless of RNA status

**Number of HCV Ab+ patients seen by both Infectious Disease and Gastroenterology

Total Flagged n=5497 (%)

Total Tested 1412 (25.7)

Total Positive 116 (8.2)

*Linked to Care 99 (85.3)

**Seen at Appointment 80 (80.8)

Missed (not tested) 1442 (26.2)

Canceled & No Show 2643 (48.1)

HCV RNA+ 57(71.3)

Total Flagged n=5497 (%)

Total Tested 1412 (25.7)

Total Positive 116 (8.2)

*Linked to Care 99 (85.3)

**Seen at Appointment 80 (80.8)

Missed (not tested) 1442 (26.2)

Canceled & No Show 2643 (48.1)

HCV RNA+ 57(71.3)

Rapid Test

146 (10.3)

Venipuncture

1266 (89.7)

Page 24: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Results

Page 25: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Results

In those HCV Ab+, 34.5% reported a history of IVDU at first appointment with a specialist.

Those infected were more likely to be men (OR 2.8 [CI95 1.8-4.1]) and persons with public insurance (OR 2.1[CI95 1.4-3.3]) than in those un-infected.

Approximately 88% of those tested and 92% of those HCV Ab+ were black/African American.

13.6% of all men tested were HCV Ab+; 11.9% were both HCV Ab+ and b/AA.

Of all b/AA men tested, 14.1% were HCV Ab+; > 8% reported by the CDC (p<0.001).

The first appointment adherence rate for those HCV infected was 80.8% compared to an overall primary care clinic appointment adherence rate of 52.1%.

Page 26: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Conclusions HCV prevalence rate of 8.2% is greater than:

CDC rate of 3.25% in the Birth Cohort (p<0.001)

Reported rate of 2% in the District of Columbia (p<0.001).

Since inception of the grant, rates have ranged between 7.8% – 10.0%.

Limitations:

Data and risk factors are collected from the EMR which often contains incomplete information. Thus, risk-factor comparisons cannot be made between those infected and not infected in this Birth Cohort testing.

As this population was largely b/AA, comparative conclusions cannot be drawn regarding race. However, these rates are very high in the b/AA community, especially amongst b/AA men and need further evaluation and attention.

In comparison to HCV rates amounting to 14.1% in b/AA men at this center, HIV rates in DC at the end of 2011 were reported at 5.4% in b/AA men.

These alarming statistics highlight the need to engage more men into harm reduction, transmission reduction and medical care.

Page 27: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Conclusions

These high prevalence rates of 8.2% and 14.1% are for patients already in care; rates would likely be higher for those not.

Sustainability needs: Utilizing veni-puncture for testing, which is covered by insurance.

Need to address missed testing opportunities as rates were equivalent to those tested.

Care navigation and education

Testing initiatives need to become standard of care and maintained as sustainable models. Need to empower patients to start to request testing

Patients are starting to speak about marketing efforts

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Future Plans

Addressing Missed Opportunities Monthly resident reminders

Monthly email update

Letters and phone calls to empower patients who were “missed opportunities”

Emergency Department Testing

Surgical Testing

MedStar-wide testing

More grant writing to address the entire Cascade of Care ….. Industry and Foundation service grants

PCORI

NIH

CDC ….

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Acknowledgements

HCV Testing Team:

Alex Geboy

Allison Daly

Candice Sewell

Sandeep Mahajan

Carmella Cole

Primary Care Clinic

Others: Tracey Gantt, Leslie Ruhno

• Funding: CDC-RFA-PS12-1209PPHF Category B, Part 3

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BFree Columbus

Columbus, Ohio

March 11, 2014

Prepared by Manju Sankarappa, Executive Director

Preetam Bekal, Program Coordinator

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To work toward sustaining long term approaches to the promotion of

health and wellness through strong partnerships that empower AAPI

individuals, families, and communities.

Voluntary group – six founding CBOs

501(c)(3) pending

Listserv (yahoo group)

Organized bi-annual Ohio Asian Health Conference

Health Through Action Grant

Informal workgroups

Tobacco Control

Hepatitis B

Domestic Violence/Mental Health

Special Priorities – Statewide Needs Assessment

National Health Through Action Initiative

Be the catalyst to improve health of the local Pan-Asian Community

Page 32: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Why Hepatitis B is important •High Prevalence –Worldwide:

•2 billion exposed

•400 million chronically infected

•1,000,000 deaths/year

•Approximately 2 people die each minute from Hepatitis B – U.S.

•12 million exposed

•1.3+ million chronically infected

•4,000 deaths/year

•Effective vaccination exists and

“Hepatitis B is a Serious Preventable Disease”

• Columbus ranks 8th highest in U.S. with foreign-born Asian and African population

Page 33: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Program Coordinator Preetam Bekal, M.D

DDE

Program Manager African Hassan Omar

Project Director Manju Sankarappa

Phlebotomist Wynette

Community Health Advocates Qodah, Muna, Lucky, Yusuf, Mursal, Ayan, Lisa, Ahmed,

Community Health Advocates HuangWei , Robert, Kosal,

Daniel, June, Carmen, Suzanne

Program Manager Asian Nancy Pyon, Chin-Yinh Shih

Office Assistant Georgie Cline

DDE

Tina, James, Kelye, James, LaDonte

B f r e e Te a m

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Overview

Bfree Columbus Prevention Activities

• Building Relationship with Community

• Building Relationship with Providers

• Building Relationship with Diverse Organizations

• Selecting the Team Members that Team players

• Training the team

• Disseminate the Grant information operation plan

Education

• Providing Objectives and Goals and Deliverables of the project

• Preparing all the necessary document for CHA’s

• Training the Program Managers and Community Health Advocates

– Nurse/Educator - Two day total 6 hour training for each Team Member

– Measuring the knowledgebase using Pre- and Post test tool

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Testing Sites

Clinics

African

Community

Event

Asian

Community

Events

Asian Health

Initiative(OSU

Free Clinic)

Noor Clinic

(OSU Free

Clinic)

Heart of Ohio

Health

Centers

Community Events

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• African Community Events

• Asian Community Events

Community Events

Chinese Festival

Helen’s Asia Kitchen

Ethiopian Community Center

Minority Health Month

Gurudwara – Sikh Community

Nepalese/Bhutanese Community Event

Asian American Community Services

Gracepoint Sanctuary

Asian Festival May 24th and 25th

Somali Community Association of Ohio -

Global Mall

Tamaya Masjid

Minority Health Month Health Fair,

Ghana Church Etheopean community

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Testing activities

• Community Events

• Free Clinics

• Health Fairs

• Festivals

• Faith-based organizations

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Site locations

• Somali Community Association of Ohio

• Global Mall

• Asian Health Fair

• Noor Community Center

• Helen’s Kitchen Restaurant

• Rardin Family Clinic – Asian and Noor Clinic

• City of Columbus Adventure Center

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Partnerships

• Ohio Department of Health • Franklin County Public Health • Columbus Public Health • Columbus Neighborhood Health Center • Franklin County Public Health • OSU Wexner Medical Center – Free Clinics • Ohio Health Gastroenterology Group • Asian American Physicians of Indian Origin • Community Based Organizations –AACS, ACSC, AFC, SCAO, LMAA,

FIACO etc • Faith-based organizations – Gurudwara, Noor Community Center,

Cambodian Temple, Lao Temple, Gracepoint Sanctuary and more

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Vaccination/Treatment -

Counseling and Referral

Collaborative Services for “B Free Columbus”

# of community events with HBV testing

Translation materials for Foreign-born participants, i.e., posters, pamphlets

Being developed as needed, have received material for Asian languages

Posters, Flyers, Banner.

Distributed in local community gathering places

Language specific liaisons

Bhutanese/Nepalese, Chinese, Cambodian, Hindi, Lao, Tagalog, Vietnamese,

Somali, Ghanaian, Ethiopian, Eritrean, Swahili

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CDC’s Programmatic Updates

E-Authentication

Done

Site Identifications

Guidelines are set and in implementation

Evaluation Webinar

Attended by Preetam Bekal and Manju Sankarappa

Data collection

Program Managers and BFree Team consisting of 20

people

Case reporting

Preetam and Manju Sankarappa

Cora Munoz and Jennifer Kue

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Stakeholders/Partners o Collaboration with Ohio Department of Health – Kathleen Koechlin

o Local health department – Denice Abbot, Virginia Brendenmuth

o Franklin County Public Health – Radhika Iyer

o Linkage to Care (medical facilities, FQHC, other providers)

o Ohio Gastroenterology Group

o OSU Hepatology group Free Clinics – OSU Free Clinics – Rardin Family Practice

o Asian Health Initiative, Noor Clinic

o Heart of Ohio Health clinics

o Capital Park, Whitehall Clinic

o Columbus Neighborhood Health Center

o Columbus Public Health – Vaccination –(Free for Underinsured and Uninsured)

o Lab services – OhioHealth, Ohio State University Labs, Mt. Carmel Labs

o Physicians on Record - Foreign-born African – Dr. Mohamed Hashi

o - Foreign-born Asian – Dr. John O’Handley

o - Foreign-born Asian – Dr. Angel Villanueva

o - Dr. Jagdish Urs – Nationwide Children’s Hospital - Dr. Bernard MOA, letter of support, MOU documenting support

o Training Activities to private providers – ODH Director has already begun the Process

o Posters are placed in Physician’ office

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Screening

• Held at least seven Hepatitis B screenings in Columbus • Results: 7.63% positive 8.89% in Foreign-born African

Community Non PPHF funding results 6.73% • After the screening, the participants receive: • 1. Personal counseling, if positive; Letter describing

results • 2. Community Health Advocate will contact • 3. Translated brochures • 4. Gift cards after screening • 5. Available resources for follow-up and vaccines

Page 44: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Screening Analysis

Population by Gender

Female 827

Male 920

Total Data

PPHF – 1568, Positive - 107

Non-PPHF 467 Positive - 22

Number Countries represented 58

Number of of screenings

36 screenings

Added more permanent site on weekends

Challenge:

Collecting correct address

Followups

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Page 46: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Resources

• Be familiar with what resources are

available right here in Columbus

• Vaccinations are available at the Columbus Health Department

• Screenings available at:

• Bfree Columbus Health screenings- visit website for date and time: www.oahcoalition.org

• Linkage to Care provided by BFree Columbus

• Contact phone number – 614-366-8214 or e-mail [email protected]

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Columbus Neighborhood Health Center, Heart of Ohio

Health Centers

Primary Care Physician

*Free clinics

*FQHC

Linkage to Care For Positive Hepatitis B

Linkage to Care For Positive

Hepatitis B

Underinsured/Ininsure

d

Uninsured

PCMH

Insured or able to payout of

pocket

Gastrenterology/ Hepatology

Monitors Liver function

tests/virus load

Asian Health Initiative, Noor Clinic,

Columbus Public Health

Treatment of Patients using

proper protocalls

Page 48: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

Comments/Questions/Answers

“Hepatitis B is a Serious Preventable Disease”

Page 49: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled
Page 50: Viral Hepatitis Testing Initiative - Sharing Results · NASTAD Webinar March 11, 2014 ... Anti-HCV Ab - : results by Provider/testing team Anti-HCV Ab + and RNA+ (Linkage) Pt counseled

For More Information Contact:

Oscar Mairena

Manager

Viral Hepatitis/Policy & Legislative Affairs

NASTAD

[email protected]

(202) 434-8058