Integrating Hepatitis into the World of Community Planning Wyoming Department of Health HIV/AIDS/Hepatitis Program March 2003
Who’s on First? Preliminary questions to be asked: Is anyone interested in the integration of Hep? Does interest start w State or Community? Is someone willing to take the lead for this initiative?
Community Initiated Important to the CPG because: Priority population includes MSMs and their partners Priority population includes injecting users and their partners Priority population includes persons incarcerated Priority interventions include knowing sero status of IDUs and co-infection (Hepatitis) Collaboration with substance abuse providers and/or corrections is a priority
State Initiated Important to State Health Dept because: Seeing an increase in co-infections (HIV/Hep) Increased surveillance documenting increase in Hepatitis B/C disease Inter-agency support for addressing HIV and Hepatitis Maximizing prevention efforts for similar risk related populations Makes good public health sense
Do Your Homework First No one is interested or has the time for new projects (new monies) unless there is something in it for them. No one has the time or money, blah, blah, blah, blah, blah No one wants to deal with things that may come up in the future…. Who actually has the decision making power and do you have their “buy-in”?
Beginning Questions What outcome do you want; what does an integrated program do/ look like? What protocols, agency/state policies and procedures currently exist that would interface with Hepatitis integration? What programs, staff, current procedures would be impacted by integration? Why should the CPG be a part of this integration effort?
Wyoming Dept of Health Interest generated simultaneously: State received ELC $$ for Hep Coordinator SCPG had prioritized IDUs & partners as risk populations HIV not popular health priority in State Other areas of interest: State Drug Court system Collaboration with Substance Abuse National interest in emergence of Hep C *Personal interest to Program Mgr & staff
Barriers Encountered Costs to screen for Hepatitis Who do you screen and where Education around what the markers mean No treatment available… Not everyone eligible Cost prohibitive Treatment ambiguity Non-responders Protocols, training, reporting, education and information Number of stakeholders who need to collaborate on the implementation of a program
State Public Health Lab Staff Physician Immunizations Wyoming HIV/AIDS/Hepatitis Program Preventive Health & Safety Program Manager Prevention Coordinator CARE Coordinator Hepatitis Coordinator Disease Intervention Spec Data Specialist Data Manager/Adm Asst Public Health Nursing County Health Nurses - CTS Public Health Officer Epidemiology Section Chief STD Manager DIS Attorney General State Epidemiologist HIV Prevention Community Planning Ryan White CARE Advisory Committee CDC *DHAP * STD *Immunization * Hepatitis/ELC
Needs Assessment Identify all stakeholders What are relationships among these entities and their relationship with the state health dept Identify the “need” for integration of hepatitis Identify advocates already involved in community planning (target pop, agencies, community experts) Identify what each stakeholder will “get out of” working for integration
Integrated Programs Educational information only Hepatitis/HIV testing, counseling, referral Case follow-up, partner notification Surveillance only Site specific (corrections only, etc.) Ryan White connection for co-infected clients only Professional training
Wyoming’s Program Incorporated into existing HIV Prevention and Care Program Hepatitis Protocol developed and disseminated to over 400 providers Video conference held statewide to introduce protocol and answer questions. Hepatitis Screening for HBV/HCV offered to anyone receiving and HIV test at a publicly funded test site. Hepatitis Information integrated into CTS training HAV and HBC vaccine offered to high risk adults at post-test session
Wyoming Program - continued Workgroup established with Corrections and Infectious Disease Physicians Hepatitis brought to “table” for CPG and CARE Advisory groups Educational information for patients and providers Active surveillance (CDC required + behavior risks) Additional $$ for testing for Hepatitis at CT sites All local (State Health) information modified to include Hepatitis issues Buy-in for substance abuse office (SAMSHA requirements) and State Drug Court agenda Program staff support, knowledge Hepatitis Visibly present everywhere Long term plan for total integration
Mapping Your Stakeholders Minority CBOs Substance Abuse Public Health Labs ? ? ? City County Health Depts Hepatitis Immunization Methadone Centers CBOs State HIV Prevention Corrections ? ? ? HIV Counseling Testing & Referral Sites
Contact Information Randal Wolfe, MPH – Hepatitis Coordinator Wyoming Department of Health HIV/AIDS/Hepatitis Program 2300 Capital Avenue, Hathaway Bldg 4th floor Cheyenne, Wyoming 82002 (307) 777-5518 rwolfe@state.wy.us Program website www.wyohiv.info