1. Hepatitis C Coordinator IHS National Epidemiology Program
VHIPs for American Indians & Alaska Natives: Integration in Indian Country
Cecile M. Town, MPH
Hepatitis C Coordinator
IHS National Epidemiology Program
Albuquerque, NM

2. Introduction Indian Country IHS Background IHS Hepatitis Program
AI/AN VHIPS

3. IHS Areas Albuquerque Portland Billings California Phoenix Oklahoma
Nashville
Navajo
Tucson
Alaska
Aberdeen
Bemidji

4. IHS/Tribal/Urban (ITU) Facilities
Service Units
IHS
36 hospitals, 63 health centers, 44 health stations and 5 residential treatment centers
Tribal
13 hospitals, 158 health centers, 79 health stations, 170 Alaska village clinics
34 Urban Indian Health Centers

5. IHS Viral Hepatitis Program
Component of the IHS National Epidemiology Program
Strong level of cooperation with CDC
Hepatitis Coordinator
Hepatitis C Coordinator

6. Hepatitis Activities at IHS
VHIPs
VHET – Salish Kootenai College
Policy development
Clinician & public education
Epidemiologic research

7. American Indian/Alaska Native VHIPs
Project findings may apply across Indian country
Source for AI/AN specific integrated data

8. Approaches to Integration
Culturally appropriate
Readily available
Diverse settings
Medical
Detoxification
Rehabilitation

9. Na’Nizhoozhi Center (NCI)
Gallup, NM
Inpatient short-term alcohol treatment center
Mixed rural & urban Navajo population

10. Gallup & Vicinity

11. NCI Programs Protective custody STD, HIV, and hepatitis prevention
STD/HIV Assessment, Prevention & Education (SHAPE)

12. An Integration Collaboration
Funded by CDC & HRSA
Collaborators
NMDOH
IHS
Navajo Nation Behavioral Health
Navajo AIDS Network
Navajo Nation Social Hygiene
University of New Mexico

13. NCI VHIP Program $58,420 - Year 2 Part-time administrative coordinator
1.5 Nurse Assistant FTEs
1.0 Nurse Assistant FTE (HRSA)

14. NCI VHIP Unique Features
Navajo language counseling
Method for comprehensive testing to high risk population
Staff involved in STD outbreaks

15. Lessons Learned Private counseling office Staff time
Scheduled vaccination times

16. Phoenix Indian Medical Center (PIMC)
Phoenix, AZ
Tertiary-care IHS medical center
Tribally mixed IHS population

17. Ideal Integration Setting
Existing STD control program
HIV Center of Excellence
Partnerships
Laboratory capacity
Data management capacity

18. PIMC VHIP $43,927 – Year 2 1.0 Public Health Nurse FTE
Detailed follow-up for counseling, testing, referral
The current VHIP funding is $48,927. This funds a full time Public Health Nurse, Jerilene Begay, to perform integrated screening, counseling and post-test counseling to a population that represents a cross section of the PIMC patient population. At this time the VHIP operates only out of the PIMC facility and not the Phoenix IHS Area overall.
STD counseling referrals come from throughout the hospital – eye clinic, women’s clinic, the ER. At time of referral, patients are tested for STDs. The PIMC laboratory generates a weekly list of positive cultures which is accessed by Jeri, who checks for treatment and partner notification status.
When these individuals come in for the STD follow up services, they are offered a hepatitis panel as well as HIV testing. Prevention education and harm reduction about STDs, HIV and Hepatitis is offered at the same time as testing. Post-test counseling for the Hepatitis and HIV is then available by Jeri during a period of

19. PIMC VHIP Unique Features
Use of Resource Patient Management System (RPMS)
STD Task Force
Cross section of patient population

20. PIMC VHIP Developments
Need for operations base
Data access procedures
Case management registry adaptations

21. VHIP Activities NCI PIMC SIHB Risk assessment  Testing
Results based vaccination
Post-test counseling
Education & harm reduction
Provider training
Referral
Communicable Disease Reporting

22. IHS Integration Strengths
Integration is the IHS model
Similar to an HMO
History of close IHS/CDC collaboration
Centralized decision-making
Standards of care
Implementation