1. Integrating Hepatitis into the World of Community Planning
Wyoming Department of Health
HIV/AIDS/Hepatitis Program
March 2003

2. 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?

3. 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

4. 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

5. 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”?

6. 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?

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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)
Program website