Adult Hepatitis A and B Vaccination in Traditional and Non-Traditional Sites, North Carolina Beth Rowe-West, Head Immunization Branch Division of Public.

Slides:



Advertisements
Similar presentations
Michigan Adolescent Screening Project- Community Partnerships MDCH.
Advertisements

Integration of Viral Hepatitis Prevention with STD Prevention: What Health Professionals Should Know Presenter: Jay Todd, Training and Public Education.
Assessing the Training Needs of Managed Care Providers: Implications for STD Clinical Training Targeting this Hard-to- Reach Group by the Eastern Quadrant.
Operation H.O.P.E.F.U.L. Sean McIntosh, AS Program Coordinator Faculty, Florida/Caribbean AIDS Education and Training Center.
Florida Department of Health HIV/AIDS Section Division of Disease Control and Health Protection Annual data trends as of 12/31/2013 Living (Prevalence)
Expanding Connecticut’s ADAP in a Reformed Health System By Deborah Gosselin Nurse Consultant.
Nationals HIV/AIDS Strategy and how the mission of Women Accepting Responsibility, Inc. is helping to meet this goal. By She’kell Hutchinson Program Director,
SOUTH CAROLINA EPIDEMIOLOGIC PROFILE Data available in an Integrated Epidemiologic Profile Core Epi Section Socio-demographic characteristics of.
Evaluating the Impact of Integrating Viral Hepatitis Services for HIV and STD Prevention Moderator: Danni Lentine.
Syphilis and HIV screening initiatives in North Carolina jails Lynne A. Sampson PhD, MPH HIV/STD Update September 25, 2008.
MSM Syphilis Prevention: Sexual Identity and Intersecting Social Networks FR Bloom, A Goodfellow, M Berry, and MM Hayes Centers for Disease Control and.
STD Services in Detention in Los Angeles County Melina R. Boudov, MA Project Director LA County Infertility Prevention Project
Arizona Department of Health Services and Rural Health Office Webinar Series: Issues in Rural Health Planning Community Health Assessment Overview Howard.
Hepatitis and Liver Cancer A National Strategy for Prevention and Control of Hepatitis B and C.
‏Hepatitis B Eliminating Transmission Preventing Disease* John W. Ward, M.D. Division of Viral Hepatitis Centers for Disease Control and Prevention * The.
HIV/AIDS Prevention Committee Public Meeting November 21, 2013.
Incorporating HIV and Viral Hepatitis Testing and Referral into Idaho Drug Court Programs Presented by Idaho Advisory Council on HIV and AIDS, Bebe Thompson,
1 HIV/STD Trends in Texas Sharon K. Melville, M.D., M.P.H. Texas Department of State Health Services Texas Public Health Association April 22, 2010.
Linking STD and HIV Morbidity and Risk Behaviors in Indiana James D. Beall, MA Sr. Public Health Advisor Indiana State Department of Health.
HIV Infection Among Those with an Injection Drug Use*- Associated Risk, Florida, 2012 Florida Department of Health HIV/AIDS and Hepatitis Section Division.
African Americans and HIV: CA Office of AIDS Response Michelle Roland, MD Chief, Office of AIDS California Department of Public Health.
HIV/STD Epidemiology in Oklahoma HIV/STD Service Division of Prevention and Preparedness Oklahoma State Department of Health.
Larry Cuellar Adult Viral Hepatitis Prevention Coordinator Texas Department of State Health Services 2010 STREET OUTREACH WORKERS CONFERENCE June 21, 2010.
Mental Health and Substance Abuse Services Joe Vesowate Assistant Commissioner.
STD Control Branch Working With HIV Care Providers: The California/San Diego Experience Jessica Frasure-Williams, MPH Syphilis Elimination Coordinator,
Impact of HIV Disease, Among the Caribbean-Born, Reported in Florida, Through 2012 Florida Department of Health HIV/AIDS and Hepatitis Section Division.
Sexually Transmitted Disease (STD) Surveillance Report, 2009 Minnesota Department of Health STD Surveillance System Minnesota Department of Health STD.
Sexually Transmitted Infections Mysheika Williams Roberts, MD, MPH Medical Director Assistant Health Commissioner Columbus.
LINKAGE OF IDENTIFIED CASES TO HEALTH FACILITIES SERVICE PROVISION TO KEY POPULATIONS KABUSUNZU HC.
November 2012 Prepared for the Contra Costa Board of Supervisors by Contra Costa Health Department Needle Exchange Update.
FY 2008 – 2009 AGREEMENT ADDENDA 536 and 541 CHANGES.
1 OPA/OFP HIV Prevention Project Annual Technical Support Conference Six Years of HIV Supplemental Grants – A National Perspective Susan B. Moskosky Director,
STDs among Men who Have Sex with Men (MSM), San Francisco 2007—2010 STD Prevention and Control Services San Francisco Department of Public Health.
Epidemiology Applications Fran C. Wheeler, Ph.D School of Public Health University of South Carolina Columbia, SC (803)
Theresa L. Henry, Director of Field Services Program Integration The Virginia Experience Virginia Department of Health Division of Disease Prevention.
Epidemiology of HIV Among Men in Florida, Reported through 2012 Florida Department of Health HIV/AIDS and Hepatitis Section Division of Disease Control.
Scaling-up male circumcision programmes in the Eastern and Southern Africa Region Country update meeting HIV Testing and Counseling and Male Circumcision.
HIV Infection Among Those with an Injection Drug Use*-Associated Risk, Florida, 2014 Florida Department of Health HIV/AIDS Section Division of Disease.
Florida Department of Health HIV/AIDS and Hepatitis Section Division of Disease Control and Health Protection Annual data trends as of 12/31/2012 Living.
TB, STDs, HIV, HEPATITIS C and SUBSTANCE ABUSE: A Local Perspective Paula Kriner, MPH Imperial County Public Health Department Management of TB, STDs,
Adoption of a rapid HIV testing and counseling program facilitates state-wide implementation B. Holmes 1, L. Haynes 2, J.Korte 2, K. Brady 2 1 Lexington-Richland.
SOUTH CAROLINA EPIDEMIOLOGIC PROFILE What is the Epi Profile? The HIV/AIDS Epidemiologic Profile is a document that: Describes the HIV/AIDS epidemic.
Sexually Transmitted Disease (STD) Surveillance Report, 2008 Minnesota Department of Health STD Surveillance System Minnesota Department of Health STD.
Florida Department of Health HIV/AIDS Section Division of Disease Control and Health Protection Annual data trends as of 12/31/2014 Living (Prevalence)
Florida Department of Health HIV/AIDS and Hepatitis Section Division of Disease Control and Health Protection Annual data trends as of 12/31/2012 Living.
Focus Area 25 Sexually Transmitted Diseases Progress Review July 21, 2004.
Epidemiology of HIV Among Men in Florida, Reported through 2011 Florida Department of Health HIV/AIDS & Hepatitis Program Annual data as of 12/31/2011.
Epidemiology of HIV Among Asians and Pacific Islanders Reported in Florida, Through 2012 Florida Department of Health HIV/AIDS and Hepatitis Section Division.
HIV in America What’s New in 2012 Christopher Hurt, MD Clinical Assistant Professor NC AIDS Education and Training Center 2012 HIV Update.
Trends in the Prevalence of Hepatitis C and Hepatitis B and HIV in Seattle Injection Drug Users, 18 – 30 years old, Richard Burt, Holly Hagan,
Results from the STEAM Survey Elizabeth Barash, MPH.
Applying Science to raising immunization coverage levels Robert R. B. Grenwelge, Jr. Public Health Advisor Houston Department of Health and Human Services.
| Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official.
Hepatitis Vaccination: Closing the Gaps in New York State Debra Blog, MD, MPH Immunization Program New York State Department of Health National Immunization.
Non-Medical Staff Knowledge, Beliefs and Practices about HIV and Hepatitis for Injection Drug Users Rowe, KA 1, Tesoriero, JM 1, Heavner, KK 1, Rothman,
Unwillingness to Obtain the Influenza Vaccine among Chicago Department of Public Health Sexually Transmitted Infection (STI) Clinic Health Care Workers.
Impact of HIV Disease, Among the Caribbean-Born, Florida, 2014 Florida Department of Health HIV/AIDS Section Division of Disease Control and Health Protection.
County of Los Angeles Department of Health Services IMMUNIZATION PROGRAM Using Non-Traditional Immunization Settings to Immunize.
HIV/AIDS Epidemic in India Trends, Lessons, Challenges & Opportunities
Hepatitis C Virus Program in Chicago
Pengjun Lu, PhD, MPH;1 Kathy Byrd, MD, MPH;2
Integrating Hepatitis into the World of Community Planning
State of the Program Division of Viral Hepatitis
Believed discrimination occurred because of their:
CDC’s Adult Hepatitis B Vaccination Initiative
Implementing New ACIP Adult Hepatitis B Vaccine Recommendations Eric E
Progress in Facilitating National HCV Prevention
M Javanbakht, S Guerry, LV Smith, P Kerndt
Impact of Tenofovir Chemoprophylaxis on HIV Prevention Programs Questions and Implications from Local Experience Charles L. Henry, Director County of Los.
March 8, 2006 New ACIP Hepatitis B Recommendations
Presentation transcript:

Adult Hepatitis A and B Vaccination in Traditional and Non-Traditional Sites, North Carolina Beth Rowe-West, Head Immunization Branch Division of Public Health NCDHHS

Overview Historic vaccination efforts – children and adults Historic vaccination efforts – children and adults Current vaccination efforts – focus on adults Current vaccination efforts – focus on adults Who is at risk??? Who is at risk??? Impact on morbidity and mortality Impact on morbidity and mortality Challenges Challenges Plans for the future Plans for the future Recognition of players Recognition of players

Hepatitis B Vaccine Hepatitis B vaccine available for high risk individuals only, including contacts to confirmed cases Hepatitis B vaccine available for high risk individuals only, including contacts to confirmed cases Reporting Reporting Expansion Expansion 1993 – school pilots: California and NC 1993 – school pilots: California and NC 1994 – requirements for NC 1994 – requirements for NC 1995 – statewide school site expansion 1995 – statewide school site expansion

Hepatitis A Vaccine The Advisory Committee on Immunization Practices (ACIP) recommended that people at risk receive hepatitis A vaccination 1999 – The ACIP expanded recommendations to include children living in states with high hepatitis A incidence rates (NC was not included) 2002 – Implementation of Adult vaccination program for those at highest risk 2006 – The ACIP expanded recommendations to include all children

Hepatitis A/B Vaccination Initiatives Identifying the Need in North Carolina Data from the first 5 months of 2002 indicated that the rate of hepatitis A among MSM is elevated (1/3 of males self-reporting sexual contact with men). Data from the first 5 months of 2002 indicated that the rate of hepatitis A among MSM is elevated (1/3 of males self-reporting sexual contact with men). Of the reported cases of hepatitis A, 79% occurred in men. This was a dramatic increase in the male-to- female ratio of hepatitis A compared to previous years. Of the reported cases of hepatitis A, 79% occurred in men. This was a dramatic increase in the male-to- female ratio of hepatitis A compared to previous years.

Hepatitis A Reported Cases by Gender North Carolina,

Distribution of Hepatitis A Acute Cases Among Males by Self-Identified Sexual Preference, North Carolina, Jan 1 –May 31, Year Total number of cases StudiedMale (% of total cases) Heterosexual (% of male cases)* Homosexual or bisexual (% of male cases)* (54) 21 (55) 8 (21) (56) 11 (68) 4 (25) (71) 15 (51) 9 (31) (57) 12 (34) 6 (17) (57) 14 (63) 2 (9) 2002 (first 5 months) (79) 30 (38) 26 (33) * Percentages do not add up to 100% because not all case reports included sexual orientation of the patient

Demographic Characteristics of Hepatitis A cases North Carolina, Total cases Sex Male cases (%) Female cases (%) 112 (58) 82 (42) 83 (62) 42 (39) 133 (73) 50 (27) 64 (46) 75 (54) 194 (73) 72 (27) White (%) Black (%) Asian (%) American Indian (%) Unknown (%) 154 (79) 24 (12) 3 (2) 5 (3) 8 (4) 107 (79) 22 (16) 4 (3) 0 2 (2) 153 (84) 16 (9) 7 (4) (74) 24 (17) 3 (2) 2 (1) 7 (5) 195 (73) 49 (18) 4 (2) 5 (2) 13 (5)

Provision of Adult Hepatitis A/B Vaccine – the Barriers Funding Funding Competing priorities Competing priorities Poor overall adult immunization rates Poor overall adult immunization rates Deficits in Education and Awareness Deficits in Education and Awareness Limitations in Documentation/Reporting Limitations in Documentation/Reporting Inappropriate Storage and Handling Facilities Inappropriate Storage and Handling Facilities Capacity in Recruiting Capacity in Recruiting Capacity to Vaccinate Capacity to Vaccinate Capacity for tracking and follow-up Capacity for tracking and follow-up Political Will Political Will

Overcoming Barriers Funding Funding Supplemental 317 funds Supplemental 317 funds HIV/STD funds HIV/STD funds State funds State funds Competing priorities Competing priorities Childhood vaccine needs Childhood vaccine needs Poor adult immunization rates Poor adult immunization rates Non-traditional settings Non-traditional settings Deficits in Education and Awareness Deficits in Education and Awareness Shifting operational efforts Shifting operational efforts

Overcoming the Barriers Documentation/Reporting in Non-Traditional Sites Documentation/Reporting in Non-Traditional Sites Registries vs paper-based reports Registries vs paper-based reports Stressing the importance of accountability Stressing the importance of accountability Inadequate Storage and Handling Facilities in Non- Traditional Sites Inadequate Storage and Handling Facilities in Non- Traditional Sites Shifting educational resources at state immunization programs Shifting educational resources at state immunization programs Recruiting Recruiting Shifting resources at state immunization programs Shifting resources at state immunization programs Easy transition for existing public health clinics Easy transition for existing public health clinics Cold calls to non-traditional sites Cold calls to non-traditional sites

Overcoming the Barriers Site visits Site visits Shifting resources at state immunization programs Shifting resources at state immunization programs On site Resources – capacity to store, administer and report On site Resources – capacity to store, administer and report Local operating funds needed Local operating funds needed Political Will Political Will Local sites and their supporters must want to dedicate existing resources to this effort Local sites and their supporters must want to dedicate existing resources to this effort

Implementation of Adult Hepatitis A/B Vaccine 2002 – Pilot in 4 counties with highest incidence of hepatitis A/B 2002 – Pilot in 4 counties with highest incidence of hepatitis A/B Combination hepatitis A/B vaccines made available to all local health department HIV/STD clinics Combination hepatitis A/B vaccines made available to all local health department HIV/STD clinics Breaking the bank? Breaking the bank? Slow uptake Slow uptake Increased education to providers Increased education to providers 2007 – Notable increased uptake of hepatitis A and B vaccinations at local health departments 2007 – Notable increased uptake of hepatitis A and B vaccinations at local health departments

Risk Factors/Demographics of those receiving dose 1 hep A/B vx (n=310) in pilot counties Risk Factor AgeGenderRace MSM –(71%) (43%) 133 Male (85%) 263 White (65%) 201 MSP – (13%) (51%) 158 Female (15%) 47 Black (26%) 81 HCV – (9%) 28 >54 (6%) 19 Hispanic (7%) 22 IDU – (7%) 22 Other (2%) 6

Two of the four sites offered enhanced interventions Utilize skills of registered nurse Utilize skills of registered nurse Provide more personalized counseling Provide more personalized counseling Encouraged testing and vaccination Encouraged testing and vaccination Administered the vaccine Administered the vaccine Provide follow up, test results, and referral Provide follow up, test results, and referral Track clients to see if referrals were utilized Track clients to see if referrals were utilized

Who Did We Target? HIV positive status HIV positive status HCV positive status HCV positive status IDU IDU MSM MSM MSP MSP History of incarceration History of incarceration

Where Did We Target? HIV/STD Clinics HIV/STD Clinics Drug Treatment Centers Drug Treatment Centers Methadone Clinics Methadone Clinics Prisons/Jails Prisons/Jails Homeless shelters Homeless shelters Public Health Clinics Public Health Clinics FQHCs and RHCs (added in 2007) FQHCs and RHCs (added in 2007) FP Clinics (added in 2008) FP Clinics (added in 2008)

Let’s Look More Closely at HIV/STD Clinics Studies show high percentage of those seen in HIV/STD Clinics will be vaccinated Studies show high percentage of those seen in HIV/STD Clinics will be vaccinated Infrastructure to integrate all hepatitis services Infrastructure to integrate all hepatitis services Prevention Prevention Testing Testing Control Measures Control Measures Treatment Referrals Treatment Referrals Skilled staff Skilled staff

Total doses ordered by 93 local and regional health departments, DOC, Drug Treatment Centers Total doses ordered by 93 local and regional health departments, DOC, Drug Treatment Centers …………………… 15,695 (includes pilot project period) 2005…………………………. 13, ………………………… 12, ………………………… 26, ………………………… 26,905 If all vaccine recipients received the required 3 dose series * of Hepatitis A and B vaccine, the following number of clients would be vaccinated: 2004…………………………….5, …………………………….4, …………………………….4, …………………………….8, …………………………….8, …………………… 15,695 (includes pilot project period) 2005…………………………. 13, ………………………… 12, ………………………… 26, ………………………… 26,905 If all vaccine recipients received the required 3 dose series * of Hepatitis A and B vaccine, the following number of clients would be vaccinated: 2004…………………………….5, …………………………….4, …………………………….4, …………………………….8, …………………………….8,968 Patient specific data is not available to determine completion rates Patient specific data is not available to determine completion rates

Show Me the Money Immunization Programs WANT to vaccinate more individuals Immunization Programs WANT to vaccinate more individuals Immunization Programs primarily funded for childhood vaccinations Immunization Programs primarily funded for childhood vaccinations Flat levels of discretionary funding Flat levels of discretionary funding Generosity of HIV/STD Generosity of HIV/STD Special CDC allocations Special CDC allocations

Planning for Better Outcomes Objectives Increase the acceptance rate of high risk who are offered the vaccine Increase the acceptance rate of high risk who are offered the vaccine Increase the percentage of clients who complete the vaccine series Increase the percentage of clients who complete the vaccine series Offer and provide HCV testing to those assessed to be at high risk for Hepatitis C Offer and provide HCV testing to those assessed to be at high risk for Hepatitis C Provide a comprehensive referral packet to those who test positive for HCV Provide a comprehensive referral packet to those who test positive for HCV

Keys to Success Begin with traditional sites familiar with vaccine management, assessment, counseling, storage and handling, reporting, tracking and follow up: local health departments Begin with traditional sites familiar with vaccine management, assessment, counseling, storage and handling, reporting, tracking and follow up: local health departments Focus on HIV/STD clinics Collectively serve ~ 36,000 clients annually Focus on HIV/STD clinics Collectively serve ~ 36,000 clients annually Intensive staff training Intensive staff training Integration of hepatitis services into HIV/STD clinics, including HCV testing Integration of hepatitis services into HIV/STD clinics, including HCV testing Provision of vaccine Provision of vaccine The rural South leads the nation in reported cases of STDs, (syphilis, chlamydia and gonorrhea) and HIV/AIDS. The rural South leads the nation in reported cases of STDs, (syphilis, chlamydia and gonorrhea) and HIV/AIDS.

Success 136 participating sites 136 participating sites Collectively serve ~ 36,000 clients annually Collectively serve ~ 36,000 clients annually True measure, of course, is impact on disease burden True measure, of course, is impact on disease burden

Hepatitis A Reported Cases North Carolina

Hepatitis A Reported Cases by Gender North Carolina,

Hepatitis A Reported Cases by Gender North Carolina,

Hepatitis B, Acute Reported cases, North Carolina

Hepatitis B, Acute Reported Cases by Gender North Carolina,

Hepatitis A/B vaccine – Future Plans Possible expansion to mental health inpatient facilities Possible expansion to mental health inpatient facilities Primary focus will be on current sites: increasing uptake, completion rates and improving accountability Primary focus will be on current sites: increasing uptake, completion rates and improving accountability

The Take Home Message: Disease is Bad! Vaccine is Good!

QUESTIONS?