1. Hepatitis Training in a STD Clinical Program
Mysheika L e-Williams, MD, MPH
Medical Director, Eastern STD Clinic
Baltimore City Health Department
Emily Erbelding, MD, MPH
STD Clinical Services Director
National Hepatitis Coordinators’ Conference
San Antonio,Texas
January 29, 2003

2. Hepatitis Training in a STD Clinical Program
Learning Objectives:
Learn results of attempts to provide comprehensive training on viral hepatitis to STD program staff who possessed different background levels of professional training.

3. Hepatitis Training in a STD Clinical Program
Need for Hepatitis Training for BCHD STD staff:
1394 cases of lab reported Hep B in Baltimore City (2001)
2178 cases of lab reported Hep C in Baltimore City (2001)
2 STD clinics in Baltimore City see
35,000 pts visits per year

4. Hepatitis Training in a STD Clinical Program
Need for Hepatitis Training for BCHD
STD staff cont.
Pts who seek STD care are at high risk for exposure to hepatitis
STD clinics serve pts. that lack consistent access to health maintenance services
Ideal setting for counseling and prevention

5. Hepatitis Training in a STD Clinical Program
Methodology
Comprehensive training session was developed
Define hepatitis
Acute vs. chronic
Prevention
Morbidity and mortality

6. Hepatitis Training in a STD Clinical Program
Methodology cont.
Viral Hepatitis (A,B and C)
Mode of transmission
Epidemiology
Symptoms
Risk factors
Testing
Interpretation of serology
Sequalae of hepatitis
Treatment/Prevention

7. Hepatitis Training in a STD Clinical Program
Goals of the comprehensive training program
Identify pts. at risk for hepatitis
Interpret hepatitis serology results
Understand long-term consequences of hepatitis
To provide effective prevention counseling messages

8. Hepatitis Training in a STD Clinical Program
Participants in the training
12 clinicians (MD, PA,NP)
9 DIS
Completed a 20 item T/F and multiple choice test pre- and post-training

9. Hepatitis Training in a STD Clinical Program
Hepatitis B is sexually transmitted
TRUE FALSE
Intravenous drug use is the only risk factor for Hepatitis C
The Hepatitis B vaccine is contraindicated in individuals infected with Hepatitis C
Hepatitis C EIA detects the antigen to Hepatitis C
TRUE FALSE

10. If a patient has received the Hepatitis B vaccine, the following SHOULD be positive: A. Hepatitis Surface Antigen (HBSAg) B. Hepatitis B Surface Antibody (HBSAb) C. Hepatitis B Core Antibody (HbcAb) D. Hepatitis B DNA E. Hepatitis B e Antibody

11. Identify the body fluid with the highest concentration of Hepatitis B and C A. Vaginal fluid B. Semen C. Blood D. Urine E. Saliva

12. Hepatitis Training in a STD Clinical Program
Results from evaluation
Competency was defined as >80% on post-training evaluation
21 (12 clinicians and 9 DIS) participants completed both pre- and post-evaluations
Pre-training combined mean score was 64.5%

13. Hepatitis Training in a STD Clinical Program
Results from evaluation cont.
Post-training combined mean score was 80.5%
All 12 clinicians achieved general competency
2 (22% ) DIS achieved general competency

14. Hepatitis Training in a STD Clinical Program
Conclusions
Single session training was adequate for clinical provider staff
Minority of DIS staff demonstrated competency
Multiple training sessions may be necessary to develop proficient hepatitis prevention skills among non-clinical staff at STD settings

15. Hepatitis Training in a STD Clinical Program
Lessons learned………
Clinical staff have a strong clinical background thus providing a previous foundation of information
Staff already understood the need for hepatitis screening in our pt. population (no buy end needed)
DIS took part in other trainings including role play activities
Interpretation of serology proved to be must difficult for all

16. Hepatitis Training in a STD Clinical Program
Current practices in BCHD STD Clinics
Since June 2002, Clinicians and DIS screen all pts. who have h/o IDU or STD, h/o blood transfusion, MSM and those that request the test
DIS do post-test counseling for all negative results
Clinicians provide all positive test results and referrals

17. Special Thanks……………. Dr. Emily Erbelding Dr. Jon Ellen
Eastern STD Clinic staff
Druid STD Clinic staff