Federal Welcome: A View from the Office of HIV/AIDS and Infectious Disease Policy Director Office of the Assistant Secretary for Health NASTAD Hepatitis Technical Assistance Meeting December 6, 2016 The findings and conclusions expressed in this presentation are those of the author and do not necessarily represent the views of the Department of Health and Human Services 1

Collective Efforts With special recognition and thanks to Corinna Dan

Potential Opportunities and Challenges Selected HHS Efforts Overview Potential Opportunities and Challenges Selected HHS Efforts Viral Hepatitis Implementation Group HHS Viral Hepatitis Webpages Use of Federal Funds for SSP Curing HCV among Persons Living with HIV National Viral Hepatitis Action Plan

Potential Opportunities and Challenges Every change brings the potential for new opportunities and challenges Priorities of the new administration are not fully known re: hepatitis issues We are committed to providing and advocating for evidence-based decsions Some state programs operate under Republican leaders, others under Democratic leadership

Viral Hepatitis Implementation Group Coordinates efforts across federal agencies 23 federal departments, agencies and offices including HHS, DOJ, HUD, and VA Major efforts include: Development, implementation, and monitoring of the National Viral Hepatitis Action Plan Information sharing More consistent federal communications

HHS Viral Hepatitis Webpages www.hhs.gov/hepatitis

Use of Federal Funds for SSPs HHS guidance released on March 29, 2016 Allows federal funds to support operational components of SSPs under certain circumstances Agency-specific guidance from CDC, HRSA, SAMHSA Requires concurrence on determination of need by CDC As of 10/13: 21 requests and 17 approvals

Improving Access to HCV Treatment CMS letter to state Medicaid directors in November 2015 Ongoing monitoring and follow up Expert Meeting on Improving Access to Early HCV Treatment (September 2016) 34 stakeholders representing public and private payers, health care providers, researchers, advocates, and federal partners Examined costs and economic benefits, barriers and effective health care models, data and policy gaps; strategies to strengthen the business case Meeting summary will be posted online

Curing HCV in Persons Living with HIV Secretary’s Minority Initiative Fund $10 million to HRSA HAB (FY16-19) Jurisdictional Approach to Curing HCV among Coinfected People of Color 3 demonstration sites (Hartford, New York, Philadelphia) State Health Department Coordinating Center (NASTAD) Evaluation and Technical Assistance Center (RAND) AIDS Education and Training Center

National Viral Hepatitis Action Plan A road map for our nation’s response to viral hepatitis Promotes action, transparency, and accountability Sets goals, priorities, and measurable targets Actions to be taken Currently being updated to 2020 10

The Evolution of Our National Response 2011 2014 2017 11

Status of Viral Hepatitis 2011 - 2014 Baseline Estimate (Source) Year of Baseline Estimate Measure Future Source of Data 2014 2020 Goal Goal 1: Increase the proportion of persons who are aware of their chronic HBV infection from 33% to 66%. 33% (REACH Survey /NHANES) 2009 Proportion of persons with HBV infections who know that they are infected NHANES (No change) 66% Goal 2: Increase the proportion of persons who are aware of their chronic HCV infection from 45% to 66%. 45% (NHANES) 2010 Proportion of persons with HCV infections who know that they are infected 54% (Increased) Goal 3: Reduce the number of new cases of HCV infection by 25%. 1,229 (NNDSS) 2011 Number of reported and estimated acute hepatitis C cases in the United States NNDSS 2,195 922 Goal 4: Eliminate mother-to-child transmission of HBV. 747 (Unstable Estimate) (NVSS) Number of infants perinatally infected with HBV NVSS 952 No cases* 64.1% (NIS) Hepatitis B vaccine “birth dose” coverage NIS 72.4% 85% 12

NVHAP Development Action Plan update for 2017-2020 The Viral Hepatitis Implementation Group (VHIG) leading update and implementation 23 federal agencies from HHS, DOJ, VA, HUD, and the White House March – June 2016 conducted 12 hepatitis stakeholder calls, webinars, and meetings with non-federal partners to gather input on the updated Action Plan 13

NVHAP Vision 14

Updating our National Viral Hepatitis Action Plan for 2017 - 2020 4 National Goals Prevent New Viral Hepatitis Infections Reduce Deaths and Improve the Health of People Living with Viral Hepatitis Reduce Viral Hepatitis Health Disparities Coordinate, Monitor, and Report on Implementation of Viral Hepatitis Actions 15

Measuring Progress on Viral Hepatitis 17 viral hepatitis indicators 4 Prevent new viral hepatitis infections 4 Reduce deaths and improve the lives of people with chronic hepatitis 9 Reduce viral hepatitis health disparities * Indicators align with HP 2020 and the CDC’s (NCHHSTP) 2020 goals 16

Considerations: Elimination National Academies of Sciences, Engineering and Medicine (formerly IOM) Released report on April 11, 2016 Committee determined that: Both hepatitis B and C could be rare diseases in the US Considerable will and resources would be required to do this Follow-up report in April 2017 will address what steps must be taken Available at: nas.edu/hepatitiselimination 17

Critical Gaps in the Viral Hepatitis Response Viral hepatitis infections are increasing rather than moving toward elimination because of the opioid epidemic. There are critical gaps in the response to viral hepatitis that make elimination difficult. Existing resources do not support active surveillance in all states, Prevention messages and programs do not have sufficient reach, Screening recommendations are not being fully implemented, and Many people with viral hepatitis are not able to access timely treatment to prevent disease progression and onward transmission. 18

Key partner pre-briefings (1-2 weeks before launch) Partner webinar NVHAP Roll Out Plan Key partner pre-briefings (1-2 weeks before launch) Partner webinar Materials Action Plan, Federal Work Plan 1 pager, slides, blogs, digital tools, infographics 19

We can only achieve our vision if we all do our part and work effectively and strategically with each other.