1. 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

3. 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

4. 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

5. 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

6. Texas Year 2000 Ethnicity

7. 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?).

9. 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

11. Summary HCV Seroprevalence Studies

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

13. 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.

14. 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

15. Proposal: HCV Integration with Perinatal HBV Program

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

17. I wish they would print clearly!

18. Optical Density versus RIBA Results

19. Describing HCV Clients

20. Counseled? Tested?

21. Counseling & Testing Sites Positivity Rate by Race/Ethnicity

22. 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.

24. Counseling and Testing Sites

25. 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

26. 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

27. 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

28. 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

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