Hepatitis Training in a STD Clinical Program Mysheika LeMaile-Williams, MD, MPH Medical Director, Eastern STD Clinic Baltimore City Health Department Emily Erbelding, MD, MPH STD Clinical Services Director National Hepatitis Coordinators’ Conference San Antonio,Texas January 29, 2003

Hepatitis Training in a STD Clinical Program Learning Objectives: Learn results of attempts to provide comprehensive training on viral hepatitis to STD program staff who possessed different background levels of professional training.

Hepatitis Training in a STD Clinical Program Need for Hepatitis Training for BCHD STD staff: 1394 cases of lab reported Hep B in Baltimore City (2001) 2178 cases of lab reported Hep C in Baltimore City (2001) 2 STD clinics in Baltimore City see 35,000 pts visits per year

Hepatitis Training in a STD Clinical Program Need for Hepatitis Training for BCHD STD staff cont. Pts who seek STD care are at high risk for exposure to hepatitis STD clinics serve pts. that lack consistent access to health maintenance services Ideal setting for counseling and prevention

Hepatitis Training in a STD Clinical Program Methodology Comprehensive training session was developed Define hepatitis Acute vs. chronic Prevention Morbidity and mortality

Hepatitis Training in a STD Clinical Program Methodology cont. Viral Hepatitis (A,B and C) Mode of transmission Epidemiology Symptoms Risk factors Testing Interpretation of serology Sequalae of hepatitis Treatment/Prevention

Hepatitis Training in a STD Clinical Program Goals of the comprehensive training program Identify pts. at risk for hepatitis Interpret hepatitis serology results Understand long-term consequences of hepatitis To provide effective prevention counseling messages

Hepatitis Training in a STD Clinical Program Participants in the training 12 clinicians (MD, PA,NP) 9 DIS Completed a 20 item T/F and multiple choice test pre- and post-training

Hepatitis Training in a STD Clinical Program Hepatitis B is sexually transmitted TRUE FALSE Intravenous drug use is the only risk factor for Hepatitis C The Hepatitis B vaccine is contraindicated in individuals infected with Hepatitis C Hepatitis C EIA detects the antigen to Hepatitis C TRUE FALSE

If a patient has received the Hepatitis B vaccine, the following SHOULD be positive: A. Hepatitis Surface Antigen (HBSAg) B. Hepatitis B Surface Antibody (HBSAb) C. Hepatitis B Core Antibody (HbcAb) D. Hepatitis B DNA E. Hepatitis B e Antibody

Identify the body fluid with the highest concentration of Hepatitis B and C A. Vaginal fluid B. Semen C. Blood D. Urine E. Saliva

Hepatitis Training in a STD Clinical Program Results from evaluation Competency was defined as >80% on post-training evaluation 21 (12 clinicians and 9 DIS) participants completed both pre- and post-evaluations Pre-training combined mean score was 64.5%

Hepatitis Training in a STD Clinical Program Results from evaluation cont. Post-training combined mean score was 80.5% All 12 clinicians achieved general competency 2 (22% ) DIS achieved general competency

Hepatitis Training in a STD Clinical Program Conclusions Single session training was adequate for clinical provider staff Minority of DIS staff demonstrated competency Multiple training sessions may be necessary to develop proficient hepatitis prevention skills among non-clinical staff at STD settings

Hepatitis Training in a STD Clinical Program Lessons learned……… Clinical staff have a strong clinical background thus providing a previous foundation of information Staff already understood the need for hepatitis screening in our pt. population (no buy end needed) DIS took part in other trainings including role play activities Interpretation of serology proved to be must difficult for all

Hepatitis Training in a STD Clinical Program Current practices in BCHD STD Clinics Since June 2002, Clinicians and DIS screen all pts. who have h/o IDU or STD, h/o blood transfusion, MSM and those that request the test DIS do post-test counseling for all negative results Clinicians provide all positive test results and referrals

Special Thanks……………. Dr. Emily Erbelding Dr. Jon Ellen Eastern STD Clinic staff Druid STD Clinic staff