Utilization of Integrated Hepatitis Services Among People with a History of Injection Drug Use in an STD Clinic 2004 National STD Prevention Conference Robin R. Hennessy Karen Schlanger, MPH Isaac Weisfuse, MD, MPH New York City Department of Health and Mental Hygiene

Overview Viral Hepatitis Integration Project (VHIP) in NYC Research Question Methods Study Population Results Conclusions

VHIP Project Description Integrate viral hepatitis services in an STD/HIV clinic setting Evaluate the impact of integration Viral hepatitis services Include: –Hepatitis A vaccine –Hepatitis B vaccine (limited screening) –Hepatitis C counseling, testing and referral

Clinic and VHIP Census May 2000 – August 2003 Nearly 40,000 visits –not unique patients 7,292 individual patients received a hepatitis service

Vaccine Delivery Hepatitis A –2,223 doses given (1,674 1 st doses) –35% completed 2 dose series Hepatitis B –10,860 doses given (5,829 1 st doses) –53% returned for second dose –29% completed 3 dose series

Screening Services Hepatitis B –4,641 patients screened –2% (92) chronic carriers –17% (799) immune (due to past exposure not prior vaccination) Hepatitis C –2,559 patients screened –8% (203) anti-HCV+ –1999 Clinic Seroprevalence Study: 2%

Research Questions Does integrated hepatitis services bring new clients to the STD clinic – specifically injection drug users (IDU)? Do these new clients utilize traditional STD/HIV services?

Methods Data Collection VHIP Database –Hepatitis Services (vaccine, lab results) –Risk Assessments Medical Record Review –Reason for visit (symptoms, HIV, etc.) –Have an STD exam –IDU risk assessment –STD/HIV (tests, results, diagnosis)

Study Population May 2000 – August % (249/7,292) of patients receiving hepatitis services reported a history of IDU –19% (48/249) of these patients report current use

Hepatitis Vaccine Among IDU (N=249) 29% (73) received the 1 st dose of hepatitis A vaccine 71% (177) received the 1 st dose of hepatitis B vaccine

Hepatitis Screening Among IDU (N=249) 67% (166) tested for hepatitis B –45% (75/166) with evidence of past exposure Clinic wide: 19% past exposure 73% (181) tested for hepatitis C –57% (103/181) anti-HCV+ Clinic wide: 8% 1999 Clinic Seroprevalence Study: 2%

STD Services Among IDU (N=249) 76% (188) were interviewed by a physician –Physician documented a history of IDU for 44% (82/188) of these patients 55% (138) had an STD exam –40% (55/138) diagnosed with an STD 49% (122) were tested for HIV –5% (6/122) tested positive –8% (20/249) known to be HIV+

Results Reason for Visit Among IDU (N=249) 59% (147) of IDU are known to have visited the STD clinic specifically for hepatitis services –56 vaccine only –60 requested hepatitis services on intake (alone or in combination with other requested STD services) –31 referred from DTC for HCV testing

After excluding IDU clients who came to the STD clinic for vaccine: –80% (73/91) received an STD service in addition to their hepatitis service 64% were tested for HIV –3.8% tested positive (all reported previous HIV- results) 53% had an STD exam –22% were diagnosed with an STD Results

Small number of participants Based on self-report of IDU risk No baseline data on IDU utilization of the STD clinic Limitations

Integrated hepatitis services appear to be an incentive for IDU clients to visit the STD clinic –Almost 60% of IDU came specifically for hepatitis services Conclusions

Physicians do not consistently identify IDU risk –Nearly half of IDU clients were NOT identified by the physician Implication … –Only 29% of IDU received the recommended vaccine for hepatitis A Conclusions

Staff (including physicians) recently received training from the Harm Reduction Coalition on strategies to elicit risk factors for drug use Re-emphasize to staff that anyone who is able to ascertain drug use should recommend ALL appropriate services (hepatitis A vaccine, etc.) Increase number of STD clinics where IDU clients can access hepatitis services Improve outreach and advertising of hepatitis services in DTC, SEP and CBO that provide support to IDU populations Next Steps

Acknowledgements Susan Blank, MD, MPH Assistant Commissioner Bureau of STD Control Alan Dunn, MD Physician in Charge Riverside STD Clinic Riverside STD Clinic Staff Centers for Disease Control & Prevention Division of Viral Hepatitis

Contact Information Robin R. Hennessy NYC DOHMH Bureau of STD Control New York City Department of Health and Mental Hygiene