Hepatitis C Virus Program in Chicago Corinna Dan, BSN, RN Hepatitis C Virus Program Chicago Department of Public Health

Where We Started

Hepatitis C Program Funded CDC Division of Viral Hepatitis funded a Hepatitis C Coordinator in May 2001. Dedicated staff to coordinate program activities Previous hepatitis C activities were sporadic including: Basic count of HCV reports received Volunteer intern completed 3 months data entry Application for HCV Coordinator No education or prevention activities No screening for hepatitis C in CDPH clinics No vaccinating for HAV or HBV

Hepatitis Activities ~ 2001 Communicable Disease Program Hepatitis A surveillance, case investigation, contact prophylaxis Hepatitis B surveillance, case investigation, contact prophylaxis Hepatitis C reports received & counted Immunization Program Hepatitis B vaccination (VFC only) Perinatal hepatitis B prevention Hepatitis A & B vaccine available upon request for agencies working with high-risk adults

Chicago Facts Major urban area 250-450 hepatitis C virus reports every month- reports often incomplete & inaccurate

CDC National Hepatitis C Prevention Strategy Program Goals Developed From: CDC National Hepatitis C Prevention Strategy Healthy People 2010 Goals: Reduce hepatitis C Target: 1 new case per 100,000 population/year (Chicago target = 29 new cases/year) Increase the proportion of persons with chronic hepatitis C infection identified by State and local health departments.

Challenges & Accomplishments

Hepatitis C Program Development 2001-2002 Surveillance Screening Immunization High-risk Adolescent & Adult Outreach Education Treatment

Surveillance Acute HCV cases: Chronic HCV cases: Case definition updated Improved reporting by infection control practitioners encouraged Case investigation to determine mode of transmission/detect outbreaks Chronic HCV cases: Completed entries for 2001 in database

Surveillance Barriers No funding received for hepatitis C surveillance Personnel required for high volume of cases Reports received often incomplete, inaccurate and/or illegible

Screen Screen high risk residents through: CDPH STD/HIV specialty clinics Pilot HCV testing at one clinic by January, 2002 Contract with State Lab for expanded hepatitis C testing services Provide written materials relating to HCV testing, education, and follow-up resources Community organizations Provide limited mobile testing Provide support for HCV activities (training, resources)

Screening Barriers Limited Home Access test kits received from IDPH CDPH clinic implementation protocol burdensome Lack of resources or support from STD/HIV program Agency testing & follow-up varies widely Substance abuse agencies reluctant to use names on HCV reports/do testing on clients

Immunize Increase rates of high-risk immunization against hepatitis A and B CDPH STD/HIV specialty clinics Discuss importance of vaccination for HAV & HBV Create protocols for vaccination Provide written materials and referral resources relating to HAV and HBV vaccination Community organizations Provide vaccine for agencies with administration capacity Support hepatitis A and B immunization services Provide written materials relating to HAV and HBV vaccination

Immunization Barriers No history of high risk adult A or B vaccination in CDPH clinics Supply of HAV/HBV adult vaccine not guaranteed Community agencies have very limited vaccine administration resources Most hepatitis immunization resources focused on children

High Risk Adolescent & Adult Outreach Education, screening and immunization resources offered to community agencies focusing on high risk outreach High risk adolescent immunization continued at Cook County Juvenile Temporary Detention Center

Outreach Barriers Limited staff High-risk individuals often difficult to identify High-risk adolescents require parental approval in juvenile justice system

Education Assess resources in Chicago for HCV: Education, Testing, Counseling & Treatment Increase outreach & education regarding HCV for: Health care providers & outreach workers Community organizations Individuals Provide training for agencies to improve HCV services Trainings currently being conducted on: Hepatitis A, B & C: The facts on hepatitis Hepatitis Integration into Prevention Activities

Education Barriers Only one staff member, therefore training efforts focused on staff working with high risk adults

Treatment Identify & improve coordination of services for HCV infected residents Work with primary clinics to recognize hepatitis C and preventive measures Develop network of medical services: Recommended annual complete physical assessments for HCV positive residents Recommended ongoing primary care Coordinate with treatment facilities to serve as resources

Treatment Barriers Very few resources exist

Support Support community organizations working on hepatitis C virus programs by offering: Training regarding HCV Educational materials Technical assistance Collaboration

Where We Plan to Go…

Future Plans Surveillance: Screening: Analyze 2001 data, identify target areas for resources Begin to understand epidemiology of HCV in Chicago Work with labs to improve hepatitis reporting Continue to do/refine case investigation of acute cases Complete 2002 data entry Screening: Implement screening of high risk patients in all STD clinics Increase outreach to very high risk populations with mobile testing, e.g., corrections, drug abusers

Future Plans, con’t Immunization Immunization Program adding new staff for adult immunization activities CDPH neighborhood health center & STD/HIV clinic trainings planned for 1~2/03 regarding adult immunization with HAV, HBV and Twinrix to start asap Plan for high-risk population outreach and vaccination in corrections and substance abuse

Future Plans, con’t Assessment & Training Chicago Area agency meeting planned for April 2003 Agency survey/needs assessment to be completed at April meeting Trainings will continue to be offered to agencies working with high risk adults

Future Plans, con’t Coordination of health care for HCV infected residents April 2003 meeting will stress regular medical care for HCV infected individuals Treatment resources made available to agencies doing screening, requesting staff training or upon request

Thank you!