1. Hepatitis Vaccination: Closing the Gaps in New York State Debra Blog, MD, MPH Immunization Program New York State Department of Health National Immunization Conference March 5, 2007

2. Outline Adult Hepatitis Vaccination Program (AHVP) Overview Development of the AHVP Strategies by Setting Expansion to Substance Abuse Settings The Model Conclusions

3. Program Objectives Program objectives: –Increase awareness of the benefits of hepatitis A and B vaccination for high risk adolescents and adults through participation in the Adult Hepatitis Vaccination Program. –Provide state funded hepatitis A, hepatitis B, and combination A/B vaccine to all high risk adults and adolescents seeking any services through health department clinics and high risk service settings at no cost.

4. Program Overview Focus is on meeting the needs of high risk adults Provides outreach, education, technical assistance to providers, local health departments, clinics, and hospitals regarding hepatitis and hepatitis vaccination Immunization Program’s Vaccine Unit distributes vaccine to sites

5. Local health department immunization coordinators promote vaccination of high risk adults and coordinate local vaccination efforts Collaboration with key stakeholders is critical to reaching high risk adults

6. Protocol for Participation Site receives AHVP protocol Site fills out a one-page application Site sets up an account with the Vaccine Unit Training is given if site has never vaccinated before Site visit by regional staff if needed Each site is required to submit monthly report on doses administered

7. Development of the AHVP Initiated in 1995, by promoting hepatitis B vaccine, primarily in STD clinics Average of 6,333 doses were administered per year 1995-1999 By 2000 15/57 local health departments participated Reasons for slow growth: competing priorities, feasibility issues, concern over stability of funding

8. Strategies 2000-2005 Provision of vaccine Internal and external collaboration Expanding local health department (LHD) involvement Recruitment of new types and numbers of settings Development of educational materials Training

9. Provision of Vaccine 2002, combined A and B vaccine, Twinrix® became available and was added to the program along with hepatitis A vaccine Began to promote availability of hepatitis vaccines Integration of hepatitis vaccination in programs that did in programs that did and did not immunize and did not immunize

10. Internal and External Collaborations 2003 Hepatitis A and B Workgroup included: –Bureau of STD Control, NYSDOH –NYSDOH AIDS Institute (AI), –Bureau of Communicable Disease Control (BCDC), –Hepatitis C Coordinator –Hepatitis B Coordinator –Immunization Program –Office of Alcohol and Substance Abuse Services (OASAS), –NYS Department of Corrections (DOCS),

11. Expansion of Sites Site Type Before 2005 After 2005 STD/HIV-LHDs1757 County Jails 1030 Migrant Sites* 22 Methadone Sites 14 College STD 18 Indian Health 4 Total29125 *Through the Migrant and Seasonal Farm Worker Immunization Project

12. Educational Materials Guidance protocols Fact sheets for hepatitis A, hepatitis B and Twinrix® vaccines Posters, magnets, NYSDOH Hepatitis web page Integrated Risk Assessment Tool –Piloted in 7 county STD clinics: –Now available to order: DOH 4336 Hepatitis A and B Vaccination Training Curriculum

13. Training 2004-2005: – 623 integrated trainings combining STD, HIV, hepatitis A, B, and C –For providers and counselors etc. from SDOH, LHDs, hospitals, community health centers, jails, prisons, substance abuse programs, community-based HIV/AIDS orgs and others by BSTDC and AIDS Institute

14. Hepatitis Vaccination in Corrections 2003: County jail vaccination project initiated in 10 upstate counties 2004: Workshops conducted at 5 regional sites focusing on integration of hepatitis prevention services into correctional settings 2006: 30 counties are providing hepatitis vaccines to inmates in county jails NYSDOCS provides hepatitis vaccine to all susceptible NYS prison inmates

15. County Jail Health Services Survey Survey of all Local Health Departments (LHDs) in 2003 Purposes –to explore what services are offered by LHD staff in county jails. – To assess the feasibility of implementing adult hepatitis vaccination programs in county jails.

16. Survey Conclusions Almost half of LHDs are currently providing services in their county jail Having a working relationship with the county jail may facilitate implementation of hepatitis vaccination

17. Inmate Vaccination Record Sharing Improvement needed in this area Jails need to keep better records Need better communication between county jails and the State prison system Ad hoc workgroup formed to develop standardized vaccine information form for information –sharing between county corrections and DOCS

18. Migrant and Seasonal Farm Worker Immunization Project Began in 2003 with 3 migrant health sites and 3 federally funded community health centers serving migrants. Program now being promoted in all 57 counties. 35,000 migrant workers in 1,024 camps in NYS each year. Project provides all adult immunizations, and promotes hepatitis vaccines.

19. Doses Administered* Over 135,000 doses of vaccine administered since program began administered since program began in 1995. in 1995. 2005 vaccine doses administered: STD/HIVJails Total Hepatitis B – 7,811 463 8,274 Hepatitis A – 1,552 147 1,699 Twinrix® - 5,406 3,044 8,450 14,769 3,654 18,423 14,769 3,654 18,423 *Aggregate data, not patient specific, hard to calculate completion rates

21. New Directions: Office of Alcohol and Substance Abuse Pilot Project “Vaccinate, Don’t Procrastinate – Live Healthy”

22. OASAS/NYSDOH Pilot Project Facilitate hepatitis A/B vaccination for patients seeking services at about 12 substance abuse providers in each county Partnership between OASAS, NYSDOH, and the local health departments 6 Pilot counties

23. OASAS/NYSDOH Pilot Project Incentives - Patients receive bracelet and $5 gift card with each dose of vaccine (total $15) Addiction Treatment Centers act as host Initial 4 hour training done 3/1/06 and 3/15/06 On-going technical assistance Evaluation – mixed success, considering next steps

24. Corrections Drug Treatment STD Programs HIV/AIDS Prevention Programs Hepatitis C Prevention (Hepatitis C Coordinator) Immunization Programs (Hepatitis B Coordinators) State Plan Viral Hepatitis Prevention Viral Hepatitis Prevention at the State/Local Level – The Model

26. Conclusions It is our partnerships that make this work. It is important to work with the people who know these groups and have access to them. Each group needs a tailored approach, multiple strategies, and partnerships. Making vaccine available is crucial. Support though provider education, follow- up, training, and materials helps.

27. Acknowledgements Elizabeth Herlihy,RN, Imm. Program Guthrie Birkhead, MD CCH Susan Klein, AIDS Institute (AI) Martha Newcomb, RN BSTDC Virginia Lewkowicz, Valerie Polletta, Migrant Imm. Project Colleen Flannigan, Hepatitis C Coordinator Lester Wright, MD, NYS Department of Corrections (DOCS) Linda Klopf, RN (DOCS) Local Health Departments, IAP Coordinators Steven Kipnis, MD, OASAS

28. Additional Information dsb06@health.state.ny.us 518-473-4437 www.health.state.ny.us/diseases/communi cable/hepatitis www.health.state.ny.us/diseases/communi cable/hepatitis