1. Small Budget, Big Dreams: Missouri Hepatitis Prevention
Scott Carson
HCV Program Coordinator
Bureau of HIV/STD/Hepatitis
Section of Disease Control and Environmental Epidemiology
Missouri Department of Health and Senior Services

2. Missouri 2003 Population: 5,704,484 St. Joseph St. Louis Kansas City
Columbia
The 5,704,484 population of Missouri is largely rural. The state is bracketed on the east and west by its two large metro areas—St. Louis and Kansas City—with the rest of the state referred to “out state.”
Springfield
Cape Girardeau

3. Major Population Centers:
Kansas City:
442,768
Total Metro Area (MO):
982,410
St. Louis City:
332,223
St. Louis County:
1,009,235
1,981,879
KC is in Jackson County—essentially Jackson County IS KC
St. Louis City is separate and distinct from St. Louis County. The city is viewed as a county and is geographically quite small.
St. Charles County has a population of over 320,000
Franklin County has a population of over 98,000
Jefferson County has a population of over

4. This leaves 2,740,195 people living in “Out State Missouri.”
You might think that people in rural Missouri look like this…

5. …when “out state” actually includes people in all age brackets and various races, living in areas with high concentrations of:
Ethnic minorities
Immigrants from Eastern Europe
Methamphetamine and Injection Drug Use

6. Realities of Missouri public health:
The State Laboratory is not funded to conduct HCV tests
Only five LPHAs operate full time walk in STD/HIV testing clinics; others provide STD/HIV treatment/testing on scheduled days
The disease reporting/tracking system is limited
Local overtime and flex-time limitations inhibit off-site/off-hour testing events
Reluctance on the part of the Department of Corrections and Correctional Medical Services to conduct HCV testing and allow HAV/HBV vaccination of incarcerated individuals
MOHSAIC= Missouri Health Strategic Architecture and Information Cooperative is so inaccurate and undependable that many LPHAs have developed their own programs for tracking infections.

7. CDC Estimate:
CDC estimates the US infection rate to be 1.8%. This could mean 102,681* Missourians with HCV.
*Based on 2003 estimated population of 5,704,484
The 102,681 figure is reached by multiplying the state population by 1.8%. HOWEVER……

8. However, the number of known HCV infections in Missouri is… 23,455
HCV Reports by Year: Missouri
This is only 23% of the estimated number of HCV cases.
Reporting of new cases fluctuates annually.
Researchers in the St. Louis area estimate there are more than 36,000 people with HCV in metro St. Louis but known cases statewide are only 23,455
1.8 % of the General Population
3.9 million people infected in the U.S.
23,455 Missourians known to be infected.
8,000 – 10,000 Deaths Annually in U.S. from HCV related chronic liver disease. – this figure is from the CDC'S MMWR, October 16, 1998/vol. 47 / No. RR – 19 edition.

9. Partnerships are the Key
The HIV C&T courses now include hepatitis modules
Inter-agency collaboration facilitates HCV testing and referral
Ongoing push by DHSS and partners to to make HCV testing available statewide
DHSS seeking funding to upgrade State Laboratory capacity
Columbia-Boone County HD HCV testing program (three year grant)
MO Hepatitis C Alliance and Regional AIDS Interfaith Network (RAIN) HCV testing in NE Region (three year grant)
Two month HCV testing pilot in Jefferson County by DHSS, Washington University, and Roche
DHSS, DMH, ALF, and Roche pilot HCV testing project in methadone clinic yielded 60%-70% positivity rate
DHSS HCV program partners with HIV C&T, HIV CPG, DIS
DHSS HCV program collaborates with DMH on projects with high risk adults
DHSS HCV encourages LPHAs to seek supplemental grant funding as a means to provide HCV testing
DHSS HCV works closely with CBOs that operate HCV programs funded through grants
DHSS HCV partners with non-profit and corporate partners to fund short term targeted testing projects

10. DHSS/JCHD/Wash U/Roche HCV Pilot Program :
Duration: 12/05-2/06
HCV testing:
At JCHD clinics
At two area rehabilitation facilities
County HD will provide referral
Washington University will provide follow-up care
Data from pilot will be included in proposal for the statewide testing project

11. Proposed Statewide HCV Testing Program:
To be instituted in three phases:
Year 1: Area of MO south of I-44 corridor
Year 2: Area of MO between I-44 and I-70
Year 3: Area of MO north of I-70 corridor
Testing to be offered at:
Designated STD clinics
Ryan White point of enrollment
DMH Drug Treatment Centers
ALF will coordinate follow-up and referral for HCV+ patients

12. Year Three Year Two Year One St. Joseph Kansas City St. Louis Columbia
I-44 runs southwest from St. Louis through Springfield.
I-70 runs west from St. Louis through Kansas City
Springfield
Cape Girardeau
Year One

13. Missouri Hepatitis A/B Vaccination Initiative
Funded with carry over budget funds
Screening criteria:
Persons with history of STDs
Persons with multiple sex partners
MSM
IDU/Intra-nasal cocaine users
HIV+ and HCV+
Occupation risks
Incarcerated persons
Any self-perceived risk
Vaccination Use:
Originally limited to STD clinics (5 LPHAs)
In 2004 all interested LPHAs were invited to participate (over 80 enrolled)
LPHAs use vaccine during outreach and off site activities
LPHAs collaborate with CBOs to extend reach of initiative
30,398 doses shipped in 2004
In addition to HCV education, testing and referral DHSS HCV program operates the Missouri Hepatitis Vaccination Initiative, funded with carryover funds. The initiative provides free HAV and HBV immunizations to adults at-risk for hepatitis infection.

14. On the horizon:
Legislation to be introduced proposing general revenue funds for DHSS HCV program
HCV Summit: DHSS/LPHAs, CBOs/non-profits, universities, and pharmaceutical companies will map strategy for combating HCV in Missouri
DHSS has just created the Bureau of HIV/STD/Hepatitis to emphasize broad based disease prevention interventions

15. QUESTIONS…?