Texas Hepatitis C Initiative National Hepatitis Coordinators Conference San Antonio, TX January 2003 Gary Heseltine MD MPH Infectious Disease Epidemiology and Surveillance Division Texas Department of Health

House Bill 1652 Rep. Maxey, Danburg, Ehrhardt, Copelo, and McClendon Conduct seroprevalence survey to determine magnitude and scope of HCV infection. Develop training course for HCV counselors. Establish voluntary HCV testing centers in each public health region - HIV/STD sites. Promote public and professional education, awareness, and training on HCV. Effective September 1, 1999

Reporting of Hepatitis C Board of Health adopted new reporting rules for HCV in 2000. All newly diagnosed cases of HCV are reportable beginning 01/01/2000. Reporting is done in the same manner as before for acute hepatitis. Change from 350 acute to more than 20,000 newly diagnosed cases per year

Texas Year 2000 Population 20,500,000 residents Prevalence of HCV infection: 1.8% Estimated infections: 366,000 Occurrence of chronicity: 85% Estimated chronic infections: 310,000

Texas Year 2000 Ethnicity

Coordinating State Activities HIV/AIDS Interagency Coordinating Council HB 768 – council mandate expanded in September 2001 to include hepatitis, 19 member agencies SB 338 – call for the development of a state plan for HCV, recently completed Proposed: Interagency Council for Immunizations Goal: integrated services/linked infrastructure: HIV/STD, Immunizations, and hepatitis (TB?).

Educational Activities: Professionals Training video and hepatitis module developed for PCPE counselors – ongoing statewide training One- and two-day CME/CNE courses for health care workers - twice a year through UTSWMC Texas Medicine and Texas DO articles Exhibits at professional meetings, mailings, web info HB 2650 – requires 2 contact hours of HCV training for RN’s renewing their licenses, many offer such training Training also mandated for LCDC’s

Summary HCV Seroprevalence Studies

Austin-Travis County – CDC Demonstration Project 2000 n = 1619

David Powell Clinic 281 new HIV+ patients in 2000 68 HCV+, 24% 18 of HCV+ patients (26%) normal LFT Screen with a hepatitis panel not LFTs.

HCV in Prisons: TDCJ Study Population 157,000 Overall seroprevalence on admission 29% Males 28% and females 37% 45,000 individuals with chronic HCV 53% have evidence of past HAV infection 56% have evidence of past HBV infection 2.7% have chronic HBV infection HBV vaccination for all inmates Addressing risk behaviors - peer counselors

Proposal: HCV Integration with Perinatal HBV Program

HCV Counseling and Testing Sites Submitters – 50 PCPE Contractors - 21

I wish they would print clearly!

Optical Density versus RIBA Results

Describing HCV Clients

Counseled? Tested?

Counseling & Testing Sites Positivity Rate by Race/Ethnicity

Mode 1 is similar to Mode 0, but splits the IDU category into current injectors (those injecting in the past 12 months) and those who have injected in their lifetime, but not the past 12 months.

Counseling and Testing Sites

HCV Positives 85% were results counseled 47% were referred to treatment 7% had confirmed referral to treatment 15% were referred for immunization 2% had confirmed referral for immunization

Media Campaigns Pre- and Post-Surveys Hep C awareness increases Valley, 23% to 75% San Antonio, 34% to 63% East Texas, 59% to 93% Specific content recall 85% in Valley 70% in San Antonio 34% in East Texas Hepline – 866-4HEPABC

Next? Healthy People 2010 Goal - incidence 1/100,000 HCV prevalence in IDU’s as a barometer of success On stop shopping for services, co-infections HIV, TB Continuity of services between prisons and community, Public Health as a facilitator Integration of HCV into perinatal HBV program Incorporation of HCV specific items into BRFSS Integration of HCV and BBP messages into school health programs Developing partnerships – CBO’s, FBO’s, and others to achieve goals

Hepatitis C Activities in Texas: A Work in Progress Kate Hendricks, MD, MPH&TM; Gary Heseltine, MD, MPH; Kathi Shupe-Ricksecker, PhD; Alma Thompson; Sharon Melville, MD; Casey Blass, Celine Hanson, MD; Rose Brownridge, MD; Sharilyn Stanley, MD; Terri Garcia; Pat Cox, PhD; Elizabeth, PhD; Bruce Elliott, PhD

EIA and RIBA Antigens Test Core NS3 NS4a,b NS5a,b EIA 2 c22-3 c33c   RIBA 2 c-100-3 5-1-1 EIA 3 c22-c NS5 RIBA 3 c22-P c-100P