Florida Hepatitis and Liver Failure Prevention and Control Program Tom Liberti Bureau Chief, HIV/AIDS January 27, 2003

Florida’s Comprehensive Hepatitis Prevention Program Department of Health budget request, member projects, growing constituency Comprehensive state-wide hepatitis prevention and control initiatives estimated at over $40 million annually ($2.66/capita) $14 million request submitted, $2.5 million appropriated in 1999, $ 3.5 million each year since then

Florida: The Sunshine State Escambia Holmes Jackson Santa Rosa H o l m e s S a n t a R o s a J a c k s o n Okaloosa W Walton a l t o n W Washington Nassau a s h i n g o Gadsden G a d s d e n Leon Hamilton N a s s a u Calhoun Jefferson L e o n J e f f e r s o n M Madison a d i s o n H a m i l t o n Duval Liberty B a k Baker e r D u v a l W Wakulla Suwannee a k u l l a Taylor S u w a n n e e Columbia C o l u m b i a Bay T a y l o r Clay Gulf L a Lafayette Union f a y e t t e U n i o n Bradford C l a y St. John’s F r a Franklin n k l i n B r a d f o r d S t J o h n s i Gilchrist l c h r i s t Alachua Dixie A l a c h u a Putnam P u t n a m F l Flagler a g l e r Florida: The Sunshine State Levy M a Marion r i o n V o Volusia l u s i a Citrus C i t r u s Sumter Lake L a k e Seminole u m t e r S e m i n o l e Hernando O r a Orange n g e B r e v a r d Pasco Osceola i Hillsborough l l s b o r o u g h Pinellas Polk O s c e o l a Brevard P o l k 16 million population 67 counties Hepatitis A rate for 2001 was 5.3/100,000 Hepatitis B rate for 2001 was 3.2/100,000 90,000 cumulative AIDS cases 28,000 cumulative HIV cases I n Indian River d i a n R i v e r Manatee Hardee Okeechobee M a n a t e e H a r d e e O k e e c h o b e e St. Lucie Highlands S t L u c i e Desoto H i g h l a n d s Sarasota r o t a D e S o t o Martin Charlotte C h a r l o t t e G Glades l a d e s Hendry Lee P Palm Beach a l m B e a c h Collier B r Broward o w a r d Monroe Miami- Dade D a d e

Components of the Program Enhanced surveillance including a hepatitis registry Professional and public education Immunization and testing Comprehensive community hepatitis prevention and control projects Epidemiologic research

Hepatitis Vaccine and Testing for High Risk Adults (since March 1, 2001) • Hepatitis A and B vaccine for high risk adults free of charge • Hepatitis B and C testing for high risk adults free of charge • HBsAb, HBsAg, HBcAb (>12,000) • HCV antibody: EIA and PCR/RIBA if needed As of 12/11/02, over 24,000 doses of hepatitis A vaccine and 36,000 doses of hepatitis B vaccine were ordered by CHD Counties integrating with HIV/AIDS, STDs, Epidemiology, Immunization, and other programs

Florida Hepatitis and Liver Failure Prevention and Control Program Escambia Holmes Jackson Santa Rosa H o l m e s S a n t a R o s a J a c k s o n Okaloosa W Walton a l t o n W Washington Nassau a s h i n g o Gadsden G a d s d e n Leon Jefferson Hamilton N a s s a u Calhoun L e o n J e f f e r s o n M Madison a d i s o n H a m i l t o n Liberty Suwannee B a k Baker e r D u Duval v a l W Wakulla a k u l l a Taylor S u w a n n e e Columbia C o l u m b i a Bay T a y l o r Lafayette U Union Clay Gulf L a f a y e t t e n i o n Bradford C l a y St. John’s F r a Franklin n k l i n B r a d f o r d S t J o h n s i Gilchrist l c h r i s t Alachua Dixie A l a c h u a Putnam P u t n a m F l Flagler a g l e r Levy Florida Hepatitis and Liver Failure Prevention and Control Program Adult Hepatitis Vaccine Program County Participation – 10/10/2002 M a Marion r i o n V o Volusia l u s i a Citrus C i t r u s Sumter Lake L a k e Seminole Hernando u m t e r S e m i n o l e O r a Orange n g e B r e v a r d Pasco Osceola Hillsborough i l l s b o r o u g h Pinellas Polk O s c e o l a Brevard P o l k I n Indian River d i a n R i v e r Manatee Hardee Okeechobee M a n a t e e H a r d e e O k e e c h o b e e St. Lucie Highlands S t L u c i e Desoto H i g h l a n d s Sarasota r o t a D e S o t o Martin Charlotte C h a r l o t t e G l Glades a d e s Hepatitis A and hepatitis B vaccine available at no charge to county Hendry Lee P Palm Beach a l m B e a c h Collier B r Broward o w a r d Active programs using available hepatitis A and hepatitis B vaccine no charge to county Monroe Miami- Dade D a d e Comprehensive hepatitis and liver failure programs funded from State Health Office

Florida Hepatitis and Liver Failure Prevention and Control Program Escambia Holmes Jackson Santa Rosa H o l m e s S a n t a R o s a J a c k s o n Okaloosa W Walton a l t o n W Washington Nassau a s h i n g o Gadsden G a d s d e n Leon Jefferson Hamilton N a s s a u Calhoun L e o n J e f f e r s o n M Madison a d i s o n H a m i l t o n Liberty Suwannee B a k Baker e r D u Duval v a l W Wakulla a k u l l a Taylor S u w a n n e e Columbia C o l u m b i a Bay T a y l o r Union Clay Gulf L a Lafayette f a y e t t e U n i o n Bradford C l a y St. John’s F r Franklin a n k l i n B r a d f o r d S t J o h n s i Gilchrist l c h r i s t Alachua Dixie A l a c h u a Putnam P u t n a m F l Flagler a g l e r Levy Florida Hepatitis and Liver Failure Prevention and Control Program Adult Hepatitis Laboratory Testing Program County Participation – 10/10/2002 M Marion a r i o n V o Volusia l u s i a Citrus C i t r u s Sumter Lake L a k e Seminole u m t e r S e m i n o l e Hernando O r a Orange n g e B r e v a r d Pasco Osceola Hillsborough i l l s b o r o u g h Pinellas Polk O s c e o l a Brevard P o l k I n Indian River d i a n R i v e r Manatee Hardee Okeechobee M a n a t e e H a r d e e O k e e c h o b e e St. Lucie Highlands S t L u c i e Desoto H i g h l a n d s Sarasota r o t a D e S o t o Martin Charlotte C h a r l o t t e G l Glades a d e s Hepatitis B and hepatitis C testing (HBsAg, HBsAb, HBcAb, HCV-antibody) available at no charge to county Hendry Lee P Palm Beach a l m B e a c h Collier B r Broward o w a r d Active programs using available hepatitis B and hepatitis C testing at no charge to county Monroe Miami-Dade D a d e Comprehensive hepatitis and liver failure programs funded from State Health Office

County and Community-based Projects 9 county health department projects funded 6 (1/3 of FL population) with infrastructure funding 3 with nurse and clerk funded (Oct 2002) Each includes hepatitis A, B, and C Other counties integrating with HIV/AIDS, STDs, Epidemiology, and Immunization programs Contract provider for outreach and testing in 5 counties Contract provider for methadone clinic testing Statewide action planning meeting

Professional and Public Education 3 Statewide Hepatitis Summits Interactive CD-ROMs for hepatitis A, B, and C directed at public health work-force Web-based hepatitis information clearinghouse (internet, intranet) Hepatitis C Hotline Outdoor media (placards, billboards) Physician mailings (43,000 x 2) TV and radio campaigns

Hepatitis C Hotline • Toll-free hotline established October 1, 2000 • 1-866-FLA-HEPC • Provides hepatitis C education • Describes testing options • Offers free home test kits to high risk callers 14,896 calls as of 12/1/02; 3,709 high risk; 1,475 tests; 403 positive

Corrections 7 jail link projects with HIV/AIDS and STD 96 of 303 tested (32 %) in one jail showed evidence of prior viral hepatitis infection In another jail, 44 of 163 tested (27 %) were HCV positive Vaccination for hepatitis A and B Corrections infections workgroup (jails and prisons) Seropositivity data from Department of Corrections “Disease Lockdown” and education

Enhanced Surveillance Web – based reporting Decreased lag time for case review Case investigations (acute) Outbreak investigations and response Chronic registry

Epidemiologic Research Incidence of hepatitis in Florida Epidemiology of hepatitis in Florida Operations research Evaluation

Additional Integration Opportunities Corrections – jail and prison HIV/AIDS and Community Planning Group Immunization STD Drug treatment TB/refugee health Medicaid Family Health

Challenges Three different diseases (confusion, priorities) What to “integrate?” (C/T, education, prevention, surveillance, immunization, evaluation, clinical care, advocacy, etc.) Other programs have categorical funding Guidelines without financial backing Capacity for care, treatment, and support Public awareness

Next Steps Increase networking and participation of the community and partners Identify resources to fund implementation Statewide action planning meeting (April 2002) Prevent disease, disability and premature death due to hepatitis and liver disease